Provider Demographics
NPI:1659411536
Name:NICKELSBERG, STEVE
Entity Type:Individual
Prefix:
First Name:STEVE
Middle Name:
Last Name:NICKELSBERG
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 1:752 ASBURY AVE
Mailing Address - Street 2:
Mailing Address - City:OCEAN CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:08226-3721
Mailing Address - Country:US
Mailing Address - Phone:609-391-2121
Mailing Address - Fax:
Practice Address - Street 1:752 ASBURY AVE
Practice Address - Street 2:
Practice Address - City:OCEAN CITY
Practice Address - State:NJ
Practice Address - Zip Code:08226-3721
Practice Address - Country:US
Practice Address - Phone:609-391-2121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJNJ1504156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0184680001Medicare ID - Type Unspecified