Healthcare Provider Details

I. General information

NPI: 1982677233
Provider Name (Legal Business Name): FRED MICHAEL NICHOLS DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2006
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3317 ROUTE 94
HAMBURG NJ
07419-2552
US

IV. Provider business mailing address

3317 ROUTE 94
HAMBURG NJ
07419-2552
US

V. Phone/Fax

Practice location:
  • Phone: 973-209-1200
  • Fax: 973-209-1201
Mailing address:
  • Phone: 973-209-1200
  • Fax: 973-209-1201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberC2-0023893
License Number StateDE
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberOS9493
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberFN7479430
License Number StatePA
# 4
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberOS009392L
License Number StatePA
# 5
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number25MB05813300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: