Provider Demographics
NPI:1396832077
Name:NICOLL, ANCA MIOARA (MD)
Entity Type:Individual
Prefix:DR
First Name:ANCA
Middle Name:MIOARA
Last Name:NICOLL
Suffix:
Gender:F
Credentials:MD
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 419
Mailing Address - Street 2:WOB
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-0419
Mailing Address - Country:US
Mailing Address - Phone:973-736-8067
Mailing Address - Fax:973-736-8067
Practice Address - Street 1:GREYSTONE PARK PSYCHIATRY HOSPITAL
Practice Address - Street 2:
Practice Address - City:GREYSTONE PARK
Practice Address - State:NJ
Practice Address - Zip Code:07950
Practice Address - Country:US
Practice Address - Phone:973-538-1800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA32057207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00739648Medicaid
C56428Medicare UPIN
N1479128Medicare ID - Type Unspecified