Provider Demographics
NPI:1164815155
Name:SCARAMAZZA, NICHOLAS OLGIATI
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:OLGIATI
Last Name:SCARAMAZZA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:146 YORK RD
Mailing Address - Street 2:
Mailing Address - City:DELRAN
Mailing Address - State:NJ
Mailing Address - Zip Code:08075-2218
Mailing Address - Country:US
Mailing Address - Phone:732-456-4399
Mailing Address - Fax:
Practice Address - Street 1:146 YORK RD
Practice Address - Street 2:
Practice Address - City:DELRAN
Practice Address - State:NJ
Practice Address - Zip Code:08075-2218
Practice Address - Country:US
Practice Address - Phone:732-456-4399
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-15
Last Update Date:2015-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MT001666002255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ977522OtherDEPARTMENT OF EDUCATION STATE BOARD OF EXAMINERS-SCHOOL ATHLETIC TRAINER
NJ25MT00166600OtherAT COMMITTEE OF THE BOARD OF MEDICAL EXAMINERS