Individual
RO MI SEO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
464 HUDSON TER STE 201A, ENGLEWOOD, NJ 07632-2951
(201) 503-0828
Mailing address
369 COOLIDGE AVE, FORT LEE, NJ 07024-5053
(201) 741-4128
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
26NJ00689300
NJ
363LF0000X
Family Nurse Practitioner
33340072
NY
Other
Enumeration date
10/07/2015
Last updated
01/08/2025
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