Healthcare Provider Details

I. General information

NPI: 1063614634
Provider Name (Legal Business Name): NILDA PYRONNEAU
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2007
Last Update Date: 08/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1191 CLINTON AVE
IRVINGTON NJ
07111-2012
US

IV. Provider business mailing address

11 BEN FRANKLIN DR
FRANKLIN NJ
07416-2155
US

V. Phone/Fax

Practice location:
  • Phone: 201-965-3242
  • Fax:
Mailing address:
  • Phone: 201-965-3242
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number37PC00294700
License Number StateNJ

VIII. Authorized Official

Name: NILDA PYRONNEAU
Title or Position: MENTAL HEALTH COUNSELOR
Credential: L.P.C.
Phone: 201-965-3242