Provider Demographics
NPI:1184896235
Name:NISENHOLZ, FREDRIC DAVID (DVM)
Entity type:Individual
Prefix:DR
First Name:FREDRIC
Middle Name:DAVID
Last Name:NISENHOLZ
Suffix:
Gender:M
Credentials:DVM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 KINDERKAMACK RD
Mailing Address - Street 2:
Mailing Address - City:RIVER EDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07661-1826
Mailing Address - Country:US
Mailing Address - Phone:201-487-0118
Mailing Address - Fax:201-343-7834
Practice Address - Street 1:311 KINDERKAMACK RD
Practice Address - Street 2:
Practice Address - City:RIVER EDGE
Practice Address - State:NJ
Practice Address - Zip Code:07661-1826
Practice Address - Country:US
Practice Address - Phone:201-487-0118
Practice Address - Fax:201-343-7834
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-28
Last Update Date:2008-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ29V100117400174M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174M00000XOther Service ProvidersVeterinarian