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General NPI Number Information
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NPI Number | 1235929563
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Entity Type | Organization
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Legal Business Name | MS NICKYS BODY SHOP
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Dates
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Enumeration Date | 05/09/2025
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Last Update Date | 05/09/2025
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Provider Practice Location Address
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Address Line | 1593 US HIGHWAY 22 STE 125
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City | WATCHUNG
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State | NJ
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Zip | 07069-6507
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Country | US
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Telephone | 858-356-4259
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Fax |
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Provider Business Mailing Address
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Address Line | 514 LOCUST ST
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City | ROSELLE
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State | NJ
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Zip | 07203-1146
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/PRACTIONER
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Name | NICOLE JOHNSON
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Credential |
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Telephone | 702-268-6488
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 174H00000X
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Taxonomy Name | Health Educator
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 171400000X
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Taxonomy Name | Health & Wellness Coach
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number |
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License Number State |
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