Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | 38MC00470400 | NJ |
NPI | 1053432294 |
---|---|
Provider Name | Dr. Charles George Nicola |
First Address | New Brunswick, NJ 08901-1271 |
Second Address | Jersey City, NJ 07304 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/04/2007 |
Last Update Date | 08/07/2007 |