MEDICARE: DIANA DRAKULICH APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	26NJ00062600	NJ

General Provider Information

NPI Number	:	1285766998
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANA DRAKULICH APRN

Provider Business Mailing Address
First Line	:	615 HOPE RD STE 5
Second Line	:
City	:	EATONTOWN
State	:	NJ
Zip	:	07724-1273
Country	:	US
Telephone Number	:	732-571-1000
Fax Number	:	732-571-1156

Provider Business Practice Location Address
First Line	:	615 HOPE RD STE 5
Second Line	:
City	:	EATONTOWN
State	:	NJ
Zip	:	07724-1273
Country	:	US
Telephone Number	:	732-571-1000
Fax Number	:	732-571-1156

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/09/2007
Last Update Date	:	11/24/2009

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