Provider Demographics
NPI:1710036165
Name:FEDERICI, NICHOLAS S (PT)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:S
Last Name:FEDERICI
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:PO BOX 5906
Mailing Address - Street 2:1081 LITTLETON RD
Mailing Address - City:PARSIPPANY
Mailing Address - State:NJ
Mailing Address - Zip Code:07054-6906
Mailing Address - Country:US
Mailing Address - Phone:973-683-1351
Mailing Address - Fax:973-683-1342
Practice Address - Street 1:1081 LITTLETON RD
Practice Address - Street 2:
Practice Address - City:PARSIPPANY
Practice Address - State:NJ
Practice Address - Zip Code:07054-6906
Practice Address - Country:US
Practice Address - Phone:973-683-1351
Practice Address - Fax:973-683-1342
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2014-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00132800225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ460398Medicare ID - Type Unspecified
NJ460398Medicare PIN