1184002230 NPI number — ALLEN DANIEL NICHOLSON M.D.

Table of content: ALLEN DANIEL NICHOLSON M.D. (NPI 1184002230)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184002230 NPI number — ALLEN DANIEL NICHOLSON M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NICHOLSON
Provider First Name:
ALLEN
Provider Middle Name:
DANIEL
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1184002230
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/12/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
776 SHREWSBURY AVE STE 201
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TINTON FALLS
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07724-4507
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-530-4949
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
800 HOWARD AVE
Provider Second Line Business Practice Location Address:
YBP 133, YNHH DEPT OF ORTHOPEDICS
Provider Business Practice Location Address City Name:
NEW HAVEN
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06519-1369
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-785-2579
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/09/2015

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207X00000X , with the licence number: 25MA11115400 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207XX0005X , with the licence number: 301928 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)