Provider Demographics
NPI:1336770031
Name:DELANCEY, NICHOLAS J JR
Entity Type:Individual
Prefix:MR
First Name:NICHOLAS
Middle Name:J
Last Name:DELANCEY
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 CANDLELIGHT DR
Mailing Address - Street 2:
Mailing Address - City:EDGEWATER PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:08010-2238
Mailing Address - Country:US
Mailing Address - Phone:609-280-7452
Mailing Address - Fax:
Practice Address - Street 1:54 E SCOTT ST
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:NJ
Practice Address - Zip Code:08075-3616
Practice Address - Country:US
Practice Address - Phone:856-461-0953
Practice Address - Fax:856-461-6443
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-31
Last Update Date:2020-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI01690000183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist