Provider Demographics
NPI:1104322593
Name:REESE, NICOLETTE J
Entity type:Individual
Prefix:DR
First Name:NICOLETTE
Middle Name:J
Last Name:REESE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 SYCAMORE AVE STE 2A
Mailing Address - Street 2:
Mailing Address - City:LITTLE SILVER
Mailing Address - State:NJ
Mailing Address - Zip Code:07739-1248
Mailing Address - Country:US
Mailing Address - Phone:732-747-9310
Mailing Address - Fax:
Practice Address - Street 1:34 SYCAMORE AVE STE 2A
Practice Address - Street 2:
Practice Address - City:LITTLE SILVER
Practice Address - State:NJ
Practice Address - Zip Code:07739-1248
Practice Address - Country:US
Practice Address - Phone:732-747-9310
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-04
Last Update Date:2023-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NJ25MA11554100207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program