MEDICARE: DR. CRAIG T NUGENT DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	X011438	NY
2	111N00000X	Chiropractor	38MC00634600	NJ

General Provider Information

NPI Number	:	1124224381
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CRAIG T NUGENT DC

Provider Business Mailing Address
First Line	:	340 RAMAPO VALLEY RD
Second Line	:
City	:	OAKLAND
State	:	NJ
Zip	:	07436-2711
Country	:	US
Telephone Number	:	201-651-9100
Fax Number	:	201-651-1142

Provider Business Practice Location Address
First Line	:	340 RAMAPO VALLEY RD
Second Line	:
City	:	OAKLAND
State	:	NJ
Zip	:	07436-2711
Country	:	US
Telephone Number	:	201-651-9100
Fax Number	:	201-651-1142

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/25/2007
Last Update Date	:	09/16/2021

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