Healthcare Provider Details

I. General information

NPI: 1639084841
Provider Name (Legal Business Name): KARISSA PADILLA DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2026
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 MACLEOD LN
BLOOMFIELD NJ
07003-4305
US

IV. Provider business mailing address

35 MACLEOD LN
BLOOMFIELD NJ
07003-4305
US

V. Phone/Fax

Practice location:
  • Phone: 646-284-8790
  • Fax: 646-284-8790
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number26NR13900000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: