Provider Demographics
NPI:1760483051
Name:NICKLES, STEVEN L (DO)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:L
Last Name:NICKLES
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:470 N FRANKLIN TPKE STE 203
Mailing Address - Street 2:
Mailing Address - City:RAMSEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07446-1385
Mailing Address - Country:US
Mailing Address - Phone:201-327-0500
Mailing Address - Fax:201-327-8612
Practice Address - Street 1:470 N FRANKLIN TPKE STE 203
Practice Address - Street 2:
Practice Address - City:RAMSEY
Practice Address - State:NJ
Practice Address - Zip Code:07446-1385
Practice Address - Country:US
Practice Address - Phone:201-327-0500
Practice Address - Fax:201-327-8612
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB51932207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ527375Medicare ID - Type Unspecified
NJE39382Medicare UPIN