Healthcare Provider Details

I. General information

NPI: 1417893181
Provider Name (Legal Business Name): REBEKAH NIDA RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 04/27/2026
Certification Date: 04/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 BEAUVOIR AVE
SUMMIT NJ
07901-3533
US

IV. Provider business mailing address

262 RIVER RD
MILLINGTON NJ
07946-1315
US

V. Phone/Fax

Practice location:
  • Phone: 908-522-5000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number26NR22410900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: