Healthcare Provider Details

I. General information

NPI: 1891459509
Provider Name (Legal Business Name): NICOLE ELIZABETH PENDLETON AU.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2021
Last Update Date: 10/28/2021
Certification Date: 10/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 EASTON AVE
NEW BRUNSWICK NJ
08901-1723
US

IV. Provider business mailing address

333 RIVER ST APT 953
HOBOKEN NJ
07030-5869
US

V. Phone/Fax

Practice location:
  • Phone: 732-937-6026
  • Fax: 732-846-8911
Mailing address:
  • Phone: 508-436-3723
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number1539544
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number41YA00115400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: