Individual
DONNA NICKLES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
80 EISENHOWER DR, SUITE 200, PARAMUS, NJ 07652-1401
(201) 843-2800
(973) 939-0273
Mailing address
80 EISENHOWER DR, SUITE 200, PARAMUS, NJ 07652-1401
(201) 843-2800
(973) 939-0273
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
25MB03792500
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0105583000
AMERIHEALTH #
NJ
01
—
160055692
RAILROAD MCR #
NJ
01
—
1K4890
HEALTHNET #
NJ
01
—
2807666
AETNA HMO #
NJ
01
—
39F312
EMPIRE BCBS #
NJ
01
—
4252756
AETNA PPO #
NJ
01
—
P2631203
OXFORD #
NJ
Enumeration date
10/10/2005
Last updated
04/25/2017
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