Individual
MRS. JACQUELINE MARY NISIVOCCIA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPM
Contact information
Practice address
66 SUNSET STRIP, SUITE 306, SUCCASUNNA, NJ 07876-1345
(973) 584-4600
(973) 584-9359
Mailing address
77 ARROWGATE DR, RANDOLPH, NJ 07869-1217
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
25MD00272700
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0024911
—
NJ
Enumeration date
07/06/2006
Last updated
11/15/2007
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