Provider Demographics
NPI:1013535244
Name:BATISTA, NICOLE (DACM, LAC)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:
Last Name:BATISTA
Suffix:
Gender:F
Credentials:DACM, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6694
Mailing Address - Street 2:
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728-6694
Mailing Address - Country:US
Mailing Address - Phone:732-213-0557
Mailing Address - Fax:
Practice Address - Street 1:410 ROUTE 46 E
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07004-1972
Practice Address - Country:US
Practice Address - Phone:862-210-8189
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-14
Last Update Date:2020-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MZ00143200171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty