Healthcare Provider Details

I. General information

NPI: 1477035715
Provider Name (Legal Business Name): KAREN E PANDOLA-DILOLLE AGACNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2018
Last Update Date: 03/07/2022
Certification Date: 03/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 NEW RD STE 700
LINWOOD NJ
08221-1286
US

IV. Provider business mailing address

1 DIAMOND HILL RD
BERKELEY HEIGHTS NJ
07922-2104
US

V. Phone/Fax

Practice location:
  • Phone: 609-653-4343
  • Fax: 609-653-2060
Mailing address:
  • Phone: 908-273-4300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number26NO10707900
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number26NJ00828600
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code163WU0100X
TaxonomyUrology Registered Nurse
License Number26NO10707900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: