Healthcare Provider Details

I. General information

NPI: 1346821899
Provider Name (Legal Business Name): JESSICA MARIE ORLICH RNBSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2021
Last Update Date: 04/16/2021
Certification Date: 04/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 PROSPECT AVE
HACKENSACK NJ
07601-1915
US

IV. Provider business mailing address

89 MCINTOSH DR
MAHWAH NJ
07430-3271
US

V. Phone/Fax

Practice location:
  • Phone: 551-996-2000
  • Fax:
Mailing address:
  • Phone: 551-427-2066
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number26NR18755200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: