Healthcare Provider Details

I. General information

NPI: 1013794395
Provider Name (Legal Business Name): NICHOLLE DIANA UMANA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2023
Last Update Date: 08/16/2026
Certification Date: 08/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

591 FOREST RD
SCOTCH PLAINS NJ
07076-1732
US

IV. Provider business mailing address

591 FOREST RD
SCOTCH PLAINS NJ
07076-1732
US

V. Phone/Fax

Practice location:
  • Phone: 321-662-7557
  • Fax:
Mailing address:
  • Phone: 321-662-7557
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-2832996
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: