Individual
DARA BLUM FACCIANI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
741 NORTHFIELD AVE, WEST ORANGE, NJ 07052-1174
(973) 736-9980
Mailing address
1 DIAMOND HILL RD, BERKELEY HEIGHTS, NJ 07922-2104
(973) 736-9980
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
25MT00109600
NJ
363A00000X
Physician Assistant
Primary
25MP00403400
NJ
Other
Enumeration date
04/04/2007
Last updated
07/18/2016
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