Provider Demographics
NPI:1639259138
Name:NICCOLLAI MEDICAL PRACTICE
Entity Type:Organization
Organization Name:NICCOLLAI MEDICAL PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MUNZER
Authorized Official - Middle Name:
Authorized Official - Last Name:ARNOUK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-890-0855
Mailing Address - Street 1:219 PATERSON AVE
Mailing Address - Street 2:
Mailing Address - City:LITTLE FALLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07424-1657
Mailing Address - Country:US
Mailing Address - Phone:973-890-0855
Mailing Address - Fax:973-890-0025
Practice Address - Street 1:219 PATERSON AVE
Practice Address - Street 2:
Practice Address - City:LITTLE FALLS
Practice Address - State:NJ
Practice Address - Zip Code:07424-1657
Practice Address - Country:US
Practice Address - Phone:973-890-0855
Practice Address - Fax:973-890-0025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2008-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ82307261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
528001Medicare ID - Type Unspecified