Basic Information
| Provider Information | |||||||||
| NPI: | 1376977736 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DANIELS | ||||||||
| FirstName: | NICHOLAS | ||||||||
| MiddleName: | XAVIER | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | P.T. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 605 MAIN STREET | ||||||||
| Address2: | |||||||||
| City: | HACKENSACK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 07601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2014880488 | ||||||||
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| Practice Location | |||||||||
| Address1: | 32 PIERMONT ROAD | ||||||||
| Address2: | |||||||||
| City: | CRESSKILL | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 07626 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2015670044 | ||||||||
| FaxNumber: | 2018331390 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/21/2013 | ||||||||
| LastUpdateDate: | 03/23/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 40QA01505000 | NJ | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.