Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Nicole Phin

Individual provider Student in an Organized Health Care Education/Training Program · NPI 1760918262

Nicole Phin is a Physician Assistant in Newark, New Jersey. Qualified in 2017, 9 years ago. Practices with Summit Medical Group PA, a 1,205-clinician group and accepts Medicare assignment. Licensed in New Jersey.

Years since qualifying
9
Licensed in
NJ
In the registry since
2017
Specialties on file
2
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Practice location Address checks out

617 Broad St
Newark, NJ 07102-4403
Phone: (862) 246-7940
Fax: (862) 246-7941
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Medical Physician Assistant (primary) Taxonomy 363AM0700X · Licence 25MP00434300 (NJ)
Student in an Organized Health Care Education/Training Program Taxonomy 390200000X

Record details

NPI number1760918262
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorNo
NPI enumeratedMay 4, 2017
Last updated in NPPESAugust 7, 2023
Certification dateAugust 7, 2023
Mailing address1 Diamond Hill Rd, Berkeley Heights, NJ 07922-2104

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2017 (9 years in practice)
Group practice Summit Medical Group Pa — 1205 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

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