| Doctor Name: | MRS. JACQUELINE MARY NISIVOCCIA |
| NPI Number: | 1356372429 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | DPM |
| License Number: | 25MD00272700 |
| Business Practice Address: | 66 Sunset Strip Suite 306 Succasunna, NJ - 078761345 |
| Business Phone Number: | 9735844600 |
| Business Fax Number: | 9735849359 |
| Mailing Address: | 77 Arrowgate Dr, RANDOLPH |
| State: | NJ |
| Postal Code: | 078691217 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 07/06/2006 |
| NPI Last Update Date: | 11/15/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 213ES0103X |
| License Number: | 25MD00272700 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NJ |
| Taxonomy Type: | Podiatric Medicine & Surgery Service Providers |
| Taxonomy Classification: | Podiatrist |
| Taxonomy Specialization: | Foot & Ankle Surgery |
| Taxonomy Definition: | |