Tara Aniela Nicoletta-Gajano, PA

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

25MP000542 Issued in NJ

Practice address

1610 Route 88 Ste 203
Brick, NJ 08724-3018

Phone

(732) 840-3339

NPI assigned

Apr 17, 2008

Last updated

Mar 6, 2024By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Miss Tara Aniela Nicoletta Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1208390400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1709683200000",
    "number": "1427222710",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3600 ROUTE 66 FL 3",
            "city": "NEPTUNE",
            "state": "NJ",
            "postal_code": "077532645"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1610 ROUTE 88 STE 203",
            "city": "BRICK",
            "state": "NJ",
            "postal_code": "087243018",
            "telephone_number": "732-840-3339"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "99 Beauvoir Ave",
            "address_2": "Medical Staff Office",
            "address_purpose": "LOCATION",
            "city": "Summit",
            "state": "NJ",
            "postal_code": "079013533",
            "country_code": "US",
            "telephone_number": "908-522-5337",
            "fax_number": "908-522-4919",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "NICOLETTA-GAJANO",
        "first_name": "TARA",
        "middle_name": "ANIELA",
        "name_prefix": "Mrs.",
        "credential": "PA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-04-17",
        "last_updated": "2024-03-06",
        "certification_date": "2024-03-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "NJ",
            "license": "25MP000542",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TARA",
            "last_name": "NICOLETTA",
            "middle_name": "ANIELA",
            "prefix": "MISS",
            "credential": "PA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Nicole Nexon, MSPT
• Martha Nguyen-Keelan, OD
• Thi Theresa Nguyen, APN
• Danielle Nhan, DO
• Sophia Nichols, D.M.D.
• Kimberly D Nielsen, PT
• Nightingale Services
• Tiffini Nigro
• Frederick W. Nirschl, DDS
• Jason Adam Nitche, MD

• Surgical Physician Assistant in Brick, NJ
• Providers in Brick, NJ by specialty
• Surgical Physician Assistant in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.