Healthcare Provider Details

I. General information

NPI: 1306545512
Provider Name (Legal Business Name): MICHELLE MIRASGELDI APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2023
Last Update Date: 11/09/2023
Certification Date: 10/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3175 STATE ROUTE 10 BLDG C
DENVILLE NJ
07834-3491
US

IV. Provider business mailing address

PO BOX 95000, LB#7550
PHILADELPHIA PA
19195-7550
US

V. Phone/Fax

Practice location:
  • Phone: 201-317-4590
  • Fax: 973-343-2134
Mailing address:
  • Phone: 844-362-1735
  • Fax: 973-290-7495

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number26NJ01447600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: