Healthcare Provider Details

I. General information

NPI: 1942511688
Provider Name (Legal Business Name): ADRIANA DANIELLE FAULKNER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ADRIANA FAULKNER NGUYEN M.D.

II. Dates (important events)

Enumeration Date: 06/28/2010
Last Update Date: 07/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 PROSPECT AVE
HACKENSACK NJ
07601-1915
US

IV. Provider business mailing address

130 KINDERKAMACK RD SUITE 200
RIVER EDGE NJ
07661-1939
US

V. Phone/Fax

Practice location:
  • Phone: 551-996-2200
  • Fax: 201-489-2812
Mailing address:
  • Phone: 201-488-2660
  • Fax: 201-489-2812

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number25MA09908300
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberA119581
License Number StateCA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier0500038
Identifier TypeMEDICAID
Identifier StateNJ
Identifier Issuer
# 2
Identifier112475700
Identifier TypeMEDICAID
Identifier StateFL
Identifier IssuerFlorida Medicaid Provider ID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: