Provider Demographics
NPI:1568450690
Name:DENICOLA, NANCY A (DO)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:A
Last Name:DENICOLA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:MRS
Other - First Name:NANCY
Other - Middle Name:A
Other - Last Name:DENICOLA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:2139 RT 35 NORTH
Mailing Address - Street 2:
Mailing Address - City:HOLMDEL
Mailing Address - State:NJ
Mailing Address - Zip Code:07733
Mailing Address - Country:US
Mailing Address - Phone:732-264-6070
Mailing Address - Fax:732-264-6076
Practice Address - Street 1:2139 RT 35 NORTH
Practice Address - Street 2:
Practice Address - City:HOLMDEL
Practice Address - State:NJ
Practice Address - Zip Code:07733
Practice Address - Country:US
Practice Address - Phone:732-264-6070
Practice Address - Fax:732-264-6076
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-12
Last Update Date:2016-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB68958208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0138711Medicaid
NJMB68958OtherMEDICAL LICENSE