Healthcare Provider Details

I. General information

NPI: 1316537970
Provider Name (Legal Business Name): DAPHNEY CADATAL MSN, APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/19/2021
Last Update Date: 01/19/2021
Certification Date: 01/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 DECKER RD
BOONTON NJ
07005-9550
US

IV. Provider business mailing address

120 DECKER RD
BOONTON NJ
07005-9550
US

V. Phone/Fax

Practice location:
  • Phone: 973-462-1795
  • Fax:
Mailing address:
  • Phone: 973-462-1795
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ01095600
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number26NR10859700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: