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NPI Code Detail

MEDICARE: NICHOLAS GISH

MEDICARE: NICHOLAS GISH
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
1101YP2500XProfessional Counselor37PC00885900NJ

General Provider Information

NPI Number : 1689398638
Entity Type Code : Individual
Provider Name (Legal Business Name) : NICHOLAS GISH
Provider Business Mailing Address
First Line : PO BOX 748465
Second Line :
City : ATLANTA
State : GA
Zip : 30374-8465
Country : US
Telephone Number : 855-284-7483
Fax Number : 617-807-0958
Provider Business Practice Location Address
First Line : 505 MAIN ST
Second Line :
City : TOMS RIVER
State : NJ
Zip : 08753-7443
Country : US
Telephone Number : 855-284-7483
Fax Number : 617-807-0958
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/03/2022
Last Update Date : 10/03/2022

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Directions to “ NICHOLAS GISH ” Practice Location

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