Healthcare Provider Details

I. General information

NPI: 1063775047
Provider Name (Legal Business Name): RENEE M NADAL APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2012
Last Update Date: 04/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 2ND AVE
LONG BRANCH NJ
07740-6303
US

IV. Provider business mailing address

634 MONMOUTH AVE
PORT MONMOUTH NJ
07758-1615
US

V. Phone/Fax

Practice location:
  • Phone: 732-923-5000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ00356300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: