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NPI Code Detail

MEDICARE: STEVEN L NICKLES DO

MEDICARE: STEVEN L NICKLES DO
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
1207Q00000XFamily Medicine Physician25MB51932NJ

General Provider Information

NPI Number : 1760483051
Entity Type Code : Individual
Provider Name (Legal Business Name) : STEVEN L NICKLES DO
Provider Business Mailing Address
First Line : 470 N FRANKLIN TPKE STE 203
Second Line :
City : RAMSEY
State : NJ
Zip : 07446-1385
Country : US
Telephone Number : 201-327-0500
Fax Number : 201-327-8612
Provider Business Practice Location Address
First Line : 470 N FRANKLIN TPKE STE 203
Second Line :
City : RAMSEY
State : NJ
Zip : 07446-1385
Country : US
Telephone Number : 201-327-0500
Fax Number : 201-327-8612
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/09/2005
Last Update Date : 07/30/2020

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Directions to “ STEVEN L NICKLES DO” Practice Location

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