Provider Demographics
NPI:1427868959
Name:CABRERA, NICOLAS
Entity type:Individual
Prefix:
First Name:NICOLAS
Middle Name:
Last Name:CABRERA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:NICOLAS
Other - Middle Name:J
Other - Last Name:DAVILA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:205 FRESH PONDS RD
Mailing Address - Street 2:
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-2459
Mailing Address - Country:US
Mailing Address - Phone:732-318-2678
Mailing Address - Fax:
Practice Address - Street 1:1846 US HIGHWAY 1
Practice Address - Street 2:
Practice Address - City:NORTH BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08902-4111
Practice Address - Country:US
Practice Address - Phone:732-318-2678
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-08
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1016081171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach