Basic Information
| Provider Information | |||||||||
| NPI: | 1649282658 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NILLAS | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | S | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 593 | ||||||||
| Address2: | |||||||||
| City: | CAPE MAY COURT HOUSE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 082100593 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6094632755 | ||||||||
| FaxNumber: | 6094632757 | ||||||||
| Practice Location | |||||||||
| Address1: | 217 N MAIN ST | ||||||||
| Address2: | SUITE 205 | ||||||||
| City: | CAPE MAY COURT HOUSE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 082102165 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6094635440 | ||||||||
| FaxNumber: | 6094639888 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/12/2006 | ||||||||
| LastUpdateDate: | 03/02/2017 | ||||||||
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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 | 207RC0000X | 25MA08101400 | NJ | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 207RC0000X | MD434384 | PA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 0108758 | 05 | NJ | MEDICAID |