Healthcare Provider Details

I. General information

NPI: 1437781549
Provider Name (Legal Business Name): NICHOLAS KENNETH CURRIE P.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2020
Last Update Date: 02/06/2020
Certification Date: 02/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 CRAIG RD
MONTVALE NJ
07645-1709
US

IV. Provider business mailing address

508 5TH ST
HOBOKEN NJ
07030-2640
US

V. Phone/Fax

Practice location:
  • Phone: 888-636-7840
  • Fax:
Mailing address:
  • Phone: 803-428-8615
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number024603-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: