Provider Demographics
NPI:1902340227
Name:ECKERT, NICOLE I
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:I
Last Name:ECKERT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:I
Other - Last Name:DARZI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:4000 RIVERDALE RD
Mailing Address - Street 2:APT 222
Mailing Address - City:RIVERDALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07457-1729
Mailing Address - Country:US
Mailing Address - Phone:917-860-1370
Mailing Address - Fax:
Practice Address - Street 1:4000 RIVERDALE RD
Practice Address - Street 2:APT 222
Practice Address - City:RIVERDALE
Practice Address - State:NJ
Practice Address - Zip Code:07457-1729
Practice Address - Country:US
Practice Address - Phone:917-860-1370
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-05
Last Update Date:2016-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00701500235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist