Provider Demographics
NPI:1770313082
Name:BANCROFT, NICOLE MARINA (PHYSICIAN ASSISTANT)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:MARINA
Last Name:BANCROFT
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3 BUCKEYE LN
Mailing Address - Street 2:
Mailing Address - City:FLEMINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08822-2654
Mailing Address - Country:US
Mailing Address - Phone:908-963-7007
Mailing Address - Fax:
Practice Address - Street 1:305 N RTE 17 STE 3-100A
Practice Address - Street 2:
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-2913
Practice Address - Country:US
Practice Address - Phone:201-470-5853
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-02
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MP00856900363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant