Healthcare Provider Details

I. General information

NPI: 1700051091
Provider Name (Legal Business Name): CLARISSA FAY APN,C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2008
Last Update Date: 03/22/2021
Certification Date: 03/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

466 OLD HOOK RD STE 16
EMERSON NJ
07630-1368
US

IV. Provider business mailing address

41 GLENMERE TER
MAHWAH NJ
07430-2812
US

V. Phone/Fax

Practice location:
  • Phone: 201-391-5443
  • Fax:
Mailing address:
  • Phone: 201-785-0928
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberNN68962
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: