Healthcare Provider Details

I. General information

NPI: 1669144523
Provider Name (Legal Business Name): MAUREEN TRAVERS MORSTATT APN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2021
Last Update Date: 12/22/2021
Certification Date: 12/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1061 AVENUE C
BAYONNE NJ
07002-3328
US

IV. Provider business mailing address

PO BOX 416457
BOSTON MA
02241-6457
US

V. Phone/Fax

Practice location:
  • Phone: 201-243-0800
  • Fax: 201-243-0802
Mailing address:
  • Phone: 844-362-1735
  • Fax: 973-290-6457

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number26NJ01209600
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code364SA2100X
TaxonomyAcute Care Clinical Nurse Specialist
License Number26NJ01209600
License Number StateNJ
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number26NJ01209600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: