Healthcare Provider Details

I. General information

NPI: 1891017687
Provider Name (Legal Business Name): DR. NICOLE L GEWECKE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/19/2010
Last Update Date: 02/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 ALGONQUIN PKWY
WHIPPANY NJ
07981-1601
US

IV. Provider business mailing address

371 NEW YORK AVE FL 2
LYNDHURST NJ
07071-1431
US

V. Phone/Fax

Practice location:
  • Phone: 973-503-1500
  • Fax:
Mailing address:
  • Phone: 201-531-2221
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number28RI03332400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: