Healthcare Provider Details

I. General information

NPI: 1861846073
Provider Name (Legal Business Name): NICOLE FERSA DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2016
Last Update Date: 09/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

532 E BROAD ST
WESTFIELD NJ
07090-2116
US

IV. Provider business mailing address

532 E BROAD ST
WESTFIELD NJ
07090-2116
US

V. Phone/Fax

Practice location:
  • Phone: 908-232-3445
  • Fax:
Mailing address:
  • Phone: 908-232-3445
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number25MB10521700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: