Healthcare Provider Details

I. General information

NPI: 1659211381
Provider Name (Legal Business Name): NICHOLAS KANASKY CADC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2026
Last Update Date: 03/31/2026
Certification Date: 03/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

540 US HIGHWAY 22
BRIDGEWATER NJ
08807-2405
US

IV. Provider business mailing address

54 GILBERT AVE
ELMWOOD PARK NJ
07407-1648
US

V. Phone/Fax

Practice location:
  • Phone: 908-722-1881
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number37CA00194400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: