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NPI Code Detail

MEDICARE: NICOLE POVEROMO MS, CCC-SLP

MEDICARE: NICOLE POVEROMO MS, CCC-SLP
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
1235Z00000XSpeech-Language PathologistYS02499NJ

General Provider Information

NPI Number : 1801024492
Entity Type Code : Individual
Provider Name (Legal Business Name) : NICOLE POVEROMO MS, CCC-SLP
Provider Business Mailing Address
First Line : 39 OLD RT 84
Second Line :
City : SUSSEX
State : NJ
Zip : 07461-3941
Country : US
Telephone Number : 973-875-2645
Fax Number :
Provider Business Practice Location Address
First Line : 200 BRISTOL GLEN DR
Second Line :
City : NEWTON
State : NJ
Zip : 07860-2329
Country : US
Telephone Number : 973-300-5788
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/23/2009
Last Update Date : 06/23/2009

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Directions to “ NICOLE POVEROMO MS, CCC-SLP” Practice Location

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