Healthcare Provider Details

I. General information

NPI: 1083171177
Provider Name (Legal Business Name): VANESSA ARIAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/25/2019
Last Update Date: 10/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

92 SUMMIT AVE
HACKENSACK NJ
07601-1263
US

IV. Provider business mailing address

410 MAIN ST
RIDGEFIELD PARK NJ
07660-1128
US

V. Phone/Fax

Practice location:
  • Phone: 201-342-0066
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number26NJ00890600
License Number StateNJ

VII. Legacy identifiers

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: