Provider Demographics
NPI:1982820817
Name:PELLEGRINO, NICOLE ANNE (OD)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:ANNE
Last Name:PELLEGRINO
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:435 HURFFVILLE GRENLOCH RD
Mailing Address - Street 2:
Mailing Address - City:SEWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:08080-3633
Mailing Address - Country:US
Mailing Address - Phone:609-364-6677
Mailing Address - Fax:
Practice Address - Street 1:265 N ROUTE 73
Practice Address - Street 2:
Practice Address - City:WEST BERLIN
Practice Address - State:NJ
Practice Address - Zip Code:08091-2500
Practice Address - Country:US
Practice Address - Phone:856-753-6390
Practice Address - Fax:856-753-8776
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00595300152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist