Provider Demographics
NPI:1659039998
Name:DASS, NICHOLAS DINESH (PT)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:DINESH
Last Name:DASS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:WOODCLIFF LAKE
Mailing Address - State:NJ
Mailing Address - Zip Code:07677-8091
Mailing Address - Country:US
Mailing Address - Phone:201-746-9966
Mailing Address - Fax:
Practice Address - Street 1:123 BROADWAY
Practice Address - Street 2:
Practice Address - City:WOODCLIFF LAKE
Practice Address - State:NJ
Practice Address - Zip Code:07677-8091
Practice Address - Country:US
Practice Address - Phone:201-746-9966
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-03
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA02060400225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist