Provider Demographics
NPI:1154324234
Name:NOCHIMSON, ROSS LOUIS (DO)
Entity type:Individual
Prefix:
First Name:ROSS
Middle Name:LOUIS
Last Name:NOCHIMSON
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:PO BOX 2756
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07015-2756
Mailing Address - Country:US
Mailing Address - Phone:973-219-6516
Mailing Address - Fax:877-936-7158
Practice Address - Street 1:1187 MAIN AVE STE 3F
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07011-2252
Practice Address - Country:US
Practice Address - Phone:973-600-5687
Practice Address - Fax:877-775-3167
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101018041208VP0014X
NJMB068037208VP0014X
NY214784-1208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8042501Medicaid
H06358Medicare UPIN
NJ8042501Medicaid