Healthcare Provider Details

I. General information

NPI: 1154449734
Provider Name (Legal Business Name): DIANE GOLDBLUM-GRAFF MSN, APN, BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 02/26/2024
Certification Date: 02/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 NEW RD STE 405
LINWOOD NJ
08221-1283
US

IV. Provider business mailing address

222 NEW RD STE 405
LINWOOD NJ
08221-1283
US

V. Phone/Fax

Practice location:
  • Phone: 609-412-1717
  • Fax:
Mailing address:
  • Phone: 609-412-1717
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License NumberNJ00113400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: