Healthcare Provider Details

I. General information

NPI: 1750128641
Provider Name (Legal Business Name): DAHLIA PERSAUD NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2024
Last Update Date: 07/09/2024
Certification Date: 07/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3840 QUAKERBRIDGE RD
HAMILTON NJ
08619-1003
US

IV. Provider business mailing address

6 TANFORAN CT
MATAWAN NJ
07747-3521
US

V. Phone/Fax

Practice location:
  • Phone: 973-326-9000
  • Fax:
Mailing address:
  • Phone: 718-598-1588
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number26NJ15019700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: