Provider Demographics
NPI:1447274766
Name:ALBICOCCO, NICHOLAS S (MD)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:S
Last Name:ALBICOCCO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:195 US HIGHWAY 46
Mailing Address - Street 2:SUITE 203
Mailing Address - City:MINE HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:07803-3163
Mailing Address - Country:US
Mailing Address - Phone:973-366-7330
Mailing Address - Fax:973-989-0508
Practice Address - Street 1:195 US HIGHWAY 46
Practice Address - Street 2:SUITE 203
Practice Address - City:MINE HILL
Practice Address - State:NJ
Practice Address - Zip Code:07803-3163
Practice Address - Country:US
Practice Address - Phone:973-366-7330
Practice Address - Fax:973-989-0508
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2010-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04396400207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ222813644OtherTAX IDENTIFICATION NUMBER
NJC55910Medicare UPIN
NJ457493Medicare ID - Type Unspecified