Healthcare Provider Details

I. General information

NPI: 1821907726
Provider Name (Legal Business Name): PEI PEI APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2026
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 E HANOVER AVE
CEDAR KNOLLS NJ
07927-2070
US

IV. Provider business mailing address

441 RATZER RD
WAYNE NJ
07470-4101
US

V. Phone/Fax

Practice location:
  • Phone: 973-971-5488
  • Fax:
Mailing address:
  • Phone: 917-882-3046
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License Number26NJ15651300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: