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General NPI Number Information
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NPI Number | 1811680317
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Entity Type | Individual
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Provider Name | NICOLE MICKENDROW
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Gender | Female
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Dates
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Enumeration Date | 05/31/2023
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Last Update Date | 05/31/2023
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Provider Practice Location Address
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Address Line | 798 STATE ROUTE 35
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City | MIDDLETOWN
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State | NJ
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Zip | 07748-3410
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Country | US
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Telephone | 732-533-5741
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Fax |
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Provider Business Mailing Address
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Address Line | 4 WALTER E FORAN BLVD STE 203
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City | FLEMINGTON
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State | NJ
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Zip | 08822-4666
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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 |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 40QA02174900
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License Number State | NJ
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