MEDICARE: DR. NICOLE LYNN ELIA DMD

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	122300000X	Dentist	22DI02979400	NJ

General Provider Information

NPI Number	:	1134737091
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NICOLE LYNN ELIA DMD

Provider Business Mailing Address
First Line	:	2095 HIGHWAY 88
Second Line	:
City	:	BRICK
State	:	NJ
Zip	:	08724-3265
Country	:	US
Telephone Number	:	732-295-1616
Fax Number	:	732-892-3570

Provider Business Practice Location Address
First Line	:	2095 HIGHWAY 88
Second Line	:
City	:	BRICK
State	:	NJ
Zip	:	08724-3265
Country	:	US
Telephone Number	:	732-295-1616
Fax Number	:

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

Provider Enumeration Date	:	07/16/2020
Last Update Date	:	05/12/2026

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