Healthcare Provider Details

I. General information

NPI: 1447274766
Provider Name (Legal Business Name): NICHOLAS S. ALBICOCCO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 09/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

195 US HIGHWAY 46 SUITE 203
MINE HILL NJ
07803-3163
US

IV. Provider business mailing address

195 US HIGHWAY 46 SUITE 203
MINE HILL NJ
07803-3163
US

V. Phone/Fax

Practice location:
  • Phone: 973-366-7330
  • Fax: 973-989-0508
Mailing address:
  • Phone: 973-366-7330
  • Fax: 973-989-0508

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number25MA04396400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: