Healthcare Provider Details

I. General information

NPI: 1649117904
Provider Name (Legal Business Name): NICOLE LAURA HOGAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 WESCOTT DR STE 206
FLEMINGTON NJ
08822-4600
US

IV. Provider business mailing address

15 DUNSTABLE CT
MATAWAN NJ
07747-6672
US

V. Phone/Fax

Practice location:
  • Phone: 908-483-4000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: