Healthcare Provider Details

I. General information

NPI: 1417904046
Provider Name (Legal Business Name): ALFRED S NEMLICK, M.D., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

345 CLAREMONT AVE SUITE 15
MONTCLAIR NJ
07042-1872
US

IV. Provider business mailing address

345 CLAREMONT AVE SUITE 15
MONTCLAIR NJ
07042-1872
US

V. Phone/Fax

Practice location:
  • Phone: 973-746-1355
  • Fax: 973-746-6224
Mailing address:
  • Phone: 973-746-1355
  • Fax: 973-746-6224

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number25MA01714300
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number25MA01714300
License Number StateNJ

VIII. Authorized Official

Name: DR. ALFRED S NEMLICK
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 973-746-1355