Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 25MA11115400 | NJ |
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 301928 | NY |
NPI | 1184002230 |
---|---|
Provider Name | Allen Daniel Nicholson |
First Address | Tinton Falls, NJ 07724-4507 |
Second Address | New Haven, CT 06519-1369 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/05/2015 |
Last Update Date | 12/08/2021 |