Provider Demographics
NPI:1558941856
Name:KOMLA-AZA, NICHOLAUS GLADSTONE
Entity Type:Individual
Prefix:
First Name:NICHOLAUS
Middle Name:GLADSTONE
Last Name:KOMLA-AZA
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 1:2007 SUNNY SLOPE RD
Mailing Address - Street 2:
Mailing Address - City:BRIDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:08807-3607
Mailing Address - Country:US
Mailing Address - Phone:862-324-1402
Mailing Address - Fax:908-393-1788
Practice Address - Street 1:2007 SUNNY SLOPE RD
Practice Address - Street 2:
Practice Address - City:BRIDGEWATER
Practice Address - State:NJ
Practice Address - Zip Code:08807-3607
Practice Address - Country:US
Practice Address - Phone:862-324-1402
Practice Address - Fax:908-393-1788
Is Sole Proprietor?:No
Enumeration Date:2021-04-11
Last Update Date:2021-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide