Healthcare Provider Details

I. General information

NPI: 1023310877
Provider Name (Legal Business Name): JENNIFER PISKADLO MSN, CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2010
Last Update Date: 11/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36 MADISON AVE DREW UNIVERSITY STUDENT HEALTH SERVICES
MADISON NJ
07940-1434
US

IV. Provider business mailing address

443 MANOR AVE
CRANFORD NJ
07016-2063
US

V. Phone/Fax

Practice location:
  • Phone: 973-408-3414
  • Fax:
Mailing address:
  • Phone: 201-290-3765
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP010921
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ00398400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: