Provider Demographics
NPI:1912110966
Name:NICHOLAIDES, NIKITAS (MS, ATC, CSCS, CFST2)
Entity Type:Individual
Prefix:MR
First Name:NIKITAS
Middle Name:
Last Name:NICHOLAIDES
Suffix:
Gender:M
Credentials:MS, ATC, CSCS, CFST2
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 HONEYSUCKLE DR
Mailing Address - Street 2:
Mailing Address - City:TOWNSHIP OF WASHINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07676-5263
Mailing Address - Country:US
Mailing Address - Phone:201-664-1010
Mailing Address - Fax:
Practice Address - Street 1:627 E RIDGEWOOD AVE
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450-3310
Practice Address - Country:US
Practice Address - Phone:201-670-2800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MT000843002255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer