Individual
NICKO INOCENCIO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
1 CAPITAL WAY, PENNINGTON, NJ 08534-2520
(609) 303-4000
Mailing address
5904 DEN LEE DR, CLINTON, MD 20735-9711
(240) 640-4989
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
25MP00792900
NJ
Other
Enumeration date
08/25/2023
Last updated
08/25/2023
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