Healthcare Provider Details

I. General information

NPI: 1134737091
Provider Name (Legal Business Name): NICOLE LYNN ELIA DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2020
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2095 HIGHWAY 88
BRICK NJ
08724-3265
US

IV. Provider business mailing address

2095 HIGHWAY 88
BRICK NJ
08724-3265
US

V. Phone/Fax

Practice location:
  • Phone: 732-295-1616
  • Fax:
Mailing address:
  • Phone: 732-295-1616
  • Fax: 732-892-3570

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number22DI02979400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: