Provider Demographics
NPI:1174857866
Name:NICHOLAS, BRIAN H (LAC)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:H
Last Name:NICHOLAS
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 ELLIOT PL
Mailing Address - Street 2:
Mailing Address - City:EAST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07018-1127
Mailing Address - Country:US
Mailing Address - Phone:973-865-0733
Mailing Address - Fax:
Practice Address - Street 1:5 STANLEY RD
Practice Address - Street 2:
Practice Address - City:SOUTH ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07079-2700
Practice Address - Country:US
Practice Address - Phone:862-250-5228
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-28
Last Update Date:2019-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MZ00066300171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist