Healthcare Provider Details

I. General information

NPI: 1205359056
Provider Name (Legal Business Name): NICHOLAS CIFELLI DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2017
Last Update Date: 11/19/2025
Certification Date: 11/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1540 W PARK AVE
OCEAN NJ
07712-3191
US

IV. Provider business mailing address

5 HAMPTON CT
NEPTUNE NJ
07753-5672
US

V. Phone/Fax

Practice location:
  • Phone: 732-544-0011
  • Fax:
Mailing address:
  • Phone: 609-731-0358
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number40QA01733900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: