Healthcare Provider Details

I. General information

NPI: 1295186179
Provider Name (Legal Business Name): JANET KILROY APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2016
Last Update Date: 06/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 PROSPECT AVE
HACKENSACK NJ
07601-1915
US

IV. Provider business mailing address

53 KIWANIS DR
WAYNE NJ
07470-4149
US

V. Phone/Fax

Practice location:
  • Phone: 551-996-2386
  • Fax: 551-996-5874
Mailing address:
  • Phone: 551-996-2386
  • Fax: 551-996-5874

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License Number26NC08765300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: