Healthcare Provider Details

I. General information

NPI: 1861645160
Provider Name (Legal Business Name): MARYANNE ONITOLO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/30/2008
Last Update Date: 12/24/2019
Certification Date: 12/24/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 COUNTY RD
CLIFFWOOD NJ
07721-1021
US

IV. Provider business mailing address

200 COUNTY RD
CLIFFWOOD NJ
07721-1021
US

V. Phone/Fax

Practice location:
  • Phone: 800-950-6066
  • Fax:
Mailing address:
  • Phone: 732-925-0623
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number26NP05182100
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ00996000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: