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NPI Code Detail

MEDICARE: JEFFREY NOLL M.D.

MEDICARE: JEFFREY NOLL M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208600000XSurgery Physician25MA10633700NJ

General Provider Information

NPI Number : 1518371202
Entity Type Code : Individual
Provider Name (Legal Business Name) : JEFFREY NOLL M.D.
Provider Business Mailing Address
First Line : PO BOX 416457
Second Line :
City : BOSTON
State : MA
Zip : 02241-6457
Country : US
Telephone Number : 844-362-1735
Fax Number : 973-290-7495
Provider Business Practice Location Address
First Line : 1973 WASHINGTON VALLEY RD STE 2
Second Line :
City : MARTINSVILLE
State : NJ
Zip : 08836-2053
Country : US
Telephone Number : 732-667-1123
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/20/2014
Last Update Date : 09/25/2019

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