Healthcare Provider Details

I. General information

NPI: 1346082625
Provider Name (Legal Business Name): JOYCE LARSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2024
Last Update Date: 12/28/2025
Certification Date: 12/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

92 2ND ST
HACKENSACK NJ
07601-2191
US

IV. Provider business mailing address

65 WOOD RIDGE ST
WOOD RIDGE NJ
07075-2416
US

V. Phone/Fax

Practice location:
  • Phone: 551-996-2000
  • Fax:
Mailing address:
  • Phone: 201-783-6431
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ15137600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: