Provider Demographics
NPI:1245471986
Name:NITZKORSKI, JAMES R (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:R
Last Name:NITZKORSKI
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Gender:M
Credentials:MD
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Mailing Address - Street 1:1351 ROUTE 55
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LAGRANGEVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12540-5108
Mailing Address - Country:US
Mailing Address - Phone:845-475-9661
Mailing Address - Fax:845-475-9938
Practice Address - Street 1:45 READE PL
Practice Address - Street 2:DYSON CENTER, 3RD FLOOR
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601-3947
Practice Address - Country:US
Practice Address - Phone:845-483-6920
Practice Address - Fax:845-483-6922
Is Sole Proprietor?:No
Enumeration Date:2009-03-10
Last Update Date:2017-03-23
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Provider Licenses
StateLicense IDTaxonomies
NY2387292086X0206X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03336523Medicaid
NYA400048216Medicare PIN