Healthcare Provider Details

I. General information

NPI: 1760483051
Provider Name (Legal Business Name): STEVEN L NICKLES DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 07/30/2020
Certification Date: 07/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

470 N FRANKLIN TPKE STE 203
RAMSEY NJ
07446-1385
US

IV. Provider business mailing address

470 N FRANKLIN TPKE STE 203
RAMSEY NJ
07446-1385
US

V. Phone/Fax

Practice location:
  • Phone: 201-327-0500
  • Fax: 201-327-8612
Mailing address:
  • Phone: 201-327-0500
  • Fax: 201-327-8612

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number25MB51932
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: