Provider Demographics
NPI:1497497556
Name:MORLEY, NICHOLAS EDSON
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:EDSON
Last Name:MORLEY
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 1:553 COON CLUB RD
Mailing Address - Street 2:
Mailing Address - City:WEST WINDSOR
Mailing Address - State:VT
Mailing Address - Zip Code:05089-9685
Mailing Address - Country:US
Mailing Address - Phone:802-484-7742
Mailing Address - Fax:
Practice Address - Street 1:450 CLARKSON AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-2012
Practice Address - Country:US
Practice Address - Phone:718-245-3318
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-10
Last Update Date:2022-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program