Healthcare Provider Details

I. General information

NPI: 1790218881
Provider Name (Legal Business Name): NICOLE ALEXANDRA BRONSON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2017
Last Update Date: 03/31/2026
Certification Date: 03/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 N HARRISON ST
PRINCETON NJ
08540-3527
US

IV. Provider business mailing address

301 N HARRISON ST
PRINCETON NJ
08540-3527
US

V. Phone/Fax

Practice location:
  • Phone: 609-924-5510
  • Fax: 609-924-3577
Mailing address:
  • Phone: 609-924-5510
  • Fax: 609-924-3577

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number25MA10826800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: