Healthcare Provider Details

I. General information

NPI: 1346709367
Provider Name (Legal Business Name): NICOLE HADJILOUCAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2019
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

727 N BEERS ST # 2E
HOLMDEL NJ
07733-1514
US

IV. Provider business mailing address

727 N BEERS ST # 2E
HOLMDEL NJ
07733-1514
US

V. Phone/Fax

Practice location:
  • Phone: 732-497-1743
  • Fax:
Mailing address:
  • Phone: 732-497-1743
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number85636-20
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: