Healthcare Provider Details

I. General information

NPI: 1942643424
Provider Name (Legal Business Name): GERALDINE DOLAN APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2013
Last Update Date: 12/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1030 SAINT GEORGES AVE STE 201
AVENEL NJ
07001-1390
US

IV. Provider business mailing address

1030 SAINT GEORGES AVE STE 201
AVENEL NJ
07001-1390
US

V. Phone/Fax

Practice location:
  • Phone: 732-602-0244
  • Fax:
Mailing address:
  • Phone: 732-602-0244
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number26NJ00428600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: