Individual
ALYSHA MARENGO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
326 PINE ST, POMPTON LAKES, NJ 07442-1617
(973) 510-1341
Mailing address
326 PINE ST, POMPTON LAKES, NJ 07442-1617
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
26NR17901200
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
26NR17901200
FNP
NJ
05
—
26NR17901200
—
NJ
Enumeration date
05/28/2020
Last updated
05/28/2020
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