Healthcare Provider Details

I. General information

NPI: 1992253124
Provider Name (Legal Business Name): JOAN A ROOP APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2016
Last Update Date: 09/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 WATCHUNG AVE
CHATHAM NJ
07928-2700
US

IV. Provider business mailing address

3 VALEVUE RD
MADISON NJ
07940-1724
US

V. Phone/Fax

Practice location:
  • Phone: 973-665-0900
  • Fax:
Mailing address:
  • Phone: 973-845-6044
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0200X
TaxonomyPediatric Clinical Nurse Specialist
License Number26NC07652200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: