Individual
BRIAN NICHOLLS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1925 PACIFIC AVE, ATLANTIC CITY, NJ 08401-6713
(609) 345-4000
Mailing address
6896 W SNOWVILLE RD, BRECKSVILLE, OH 44141-3214
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
25MB06977500
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2648518000
AMERIHEALTH
NJ
01
—
30028088
KEYSTONE MERCY
NJ
01
—
60018879
HORIZON HEALTH
NJ
05
—
8812501
—
NJ
Enumeration date
05/20/2006
Last updated
12/21/2007
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