MEDICARE: MISS NANCY ELINA FRESNEL

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	363A00000X	Physician Assistant
2	363A00000X	Physician Assistant	25MP00385000	NJ

General Provider Information

NPI Number	:	1740488063
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS NANCY ELINA FRESNEL

Provider Business Mailing Address
First Line	:	1 DIAMOND HILL RD
Second Line	:
City	:	BERKELEY HEIGHTS
State	:	NJ
Zip	:	07922-2104
Country	:	US
Telephone Number	:	908-273-4300
Fax Number	:

Provider Business Practice Location Address
First Line	:	2317 CENTER ISLAND ROUTE 22
Second Line	:
City	:	UNION
State	:	NJ
Zip	:	07083
Country	:	US
Telephone Number	:	201-354-1951
Fax Number	:	201-354-1952

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

Provider Enumeration Date	:	07/08/2007
Last Update Date	:	07/25/2024

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