Healthcare Provider Details

I. General information

NPI: 1720813991
Provider Name (Legal Business Name): MEGHAN CISIEWICZ APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2024
Last Update Date: 09/05/2024
Certification Date: 09/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 WILLOW AVE
HOBOKEN NJ
07030-3808
US

IV. Provider business mailing address

16 DARTMOUTH RD
CRANFORD NJ
07016-1609
US

V. Phone/Fax

Practice location:
  • Phone: 201-418-1000
  • Fax:
Mailing address:
  • Phone: 908-421-0611
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ00462200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: