Provider Demographics
NPI:1366197782
Name:NICOLETTI, ALLEN JAMES
Entity type:Individual
Prefix:DR
First Name:ALLEN
Middle Name:JAMES
Last Name:NICOLETTI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 TWYFORD LN
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NJ
Mailing Address - Zip Code:08759-6710
Mailing Address - Country:US
Mailing Address - Phone:718-715-2174
Mailing Address - Fax:
Practice Address - Street 1:10 LINCOLN SQ
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01608-1135
Practice Address - Country:US
Practice Address - Phone:508-373-5830
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-14
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003319152W00000X
MA5544152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist