Healthcare Provider Details

I. General information

NPI: 1275022451
Provider Name (Legal Business Name): JOAN DOYLE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2018
Last Update Date: 05/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34 SYCAMORE AVE STE 2A
LITTLE SILVER NJ
07739-1248
US

IV. Provider business mailing address

338 MIDDLEWOOD RD
MIDDLETOWN NJ
07748-1316
US

V. Phone/Fax

Practice location:
  • Phone: 732-747-9310
  • Fax: 732-747-9320
Mailing address:
  • Phone: 732-433-6068
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ00806500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: