Healthcare Provider Details

I. General information

NPI: 1871996116
Provider Name (Legal Business Name): NICOLE ROSE GAREY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NICOLE ROSE KUBART PA-C

II. Dates (important events)

Enumeration Date: 10/01/2014
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 MEADOWLANDS PKWY FL 2
SECAUCUS NJ
07094-2977
US

IV. Provider business mailing address

PO BOX 825478
PHILADELPHIA PA
19182-5478
US

V. Phone/Fax

Practice location:
  • Phone: 551-999-7050
  • Fax: 201-392-3571
Mailing address:
  • Phone: 551-999-7050
  • Fax: 201-392-3571

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number25MP00436400
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number018096
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number25MP00436400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: