Provider Demographics
NPI:1942459003
Name:NEXON, NICOLE (MSPT)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:
Last Name:NEXON
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 WILDWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:POINT PLEASANT BORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08742-4256
Mailing Address - Country:US
Mailing Address - Phone:732-903-6038
Mailing Address - Fax:
Practice Address - Street 1:1610 ROUTE 88 W
Practice Address - Street 2:SUITE 103
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08724-3018
Practice Address - Country:US
Practice Address - Phone:732-785-5500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-15
Last Update Date:2009-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01168800225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
165573BC1Medicare PIN