Provider Demographics
NPI:1598982456
Name:LASCALA, NICOLE ELENA (NICOLE LASCALA)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:ELENA
Last Name:LASCALA
Suffix:
Gender:F
Credentials:NICOLE LASCALA
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:ELENA
Other - Last Name:LASCALA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:601 MONROE ST
Mailing Address - Street 2:APT. 1D
Mailing Address - City:HOBOKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07030-6314
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:20 SUMMIT ST
Practice Address - Street 2:
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052-1501
Practice Address - Country:US
Practice Address - Phone:973-736-2000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00277600171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor