Provider Demographics
NPI:1548755275
Name:NICKEL, DANE ERIK (MD)
Entity type:Individual
Prefix:
First Name:DANE
Middle Name:ERIK
Last Name:NICKEL
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Gender:M
Credentials:MD
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Mailing Address - Street 1:750 E. ADAMS STREET
Mailing Address - Street 2:DEPARTMENT OF PEDIATRIC EMERGENCY MEDICINE
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210-2306
Mailing Address - Country:US
Mailing Address - Phone:315-464-4363
Mailing Address - Fax:
Practice Address - Street 1:750 EAST ADAMS ST
Practice Address - Street 2:DEPARTMENT OF PEDIATRIC EMERGENCY MED
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-2306
Practice Address - Country:US
Practice Address - Phone:315-464-4363
Practice Address - Fax:315-464-8690
Is Sole Proprietor?:No
Enumeration Date:2018-06-26
Last Update Date:2025-06-05
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Provider Licenses
StateLicense IDTaxonomies
NY3119132080P0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY64060Medicaid