Provider Demographics
NPI:1417904046
Name:ALFRED S NEMLICK, M.D., P.A.
Entity Type:Organization
Organization Name:ALFRED S NEMLICK, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ALFRED
Authorized Official - Middle Name:S
Authorized Official - Last Name:NEMLICK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-746-1355
Mailing Address - Street 1:345 CLAREMONT AVE
Mailing Address - Street 2:SUITE 15
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07042-1872
Mailing Address - Country:US
Mailing Address - Phone:973-746-1355
Mailing Address - Fax:973-746-6224
Practice Address - Street 1:345 CLAREMONT AVE
Practice Address - Street 2:SUITE 15
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-1872
Practice Address - Country:US
Practice Address - Phone:973-746-1355
Practice Address - Fax:973-746-6224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-28
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA01714300207N00000X, 207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ25MA01714300OtherMEDICAL LICENSE
NJAN0666923OtherDEA
NJAN0666923OtherDEA
NJ25MA01714300OtherMEDICAL LICENSE