Healthcare Provider Details

I. General information

NPI: 1265515241
Provider Name (Legal Business Name): MARIANNE HOMSEY A.P.N.C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 RAMAPO VALLEY RD
MAHWAH NJ
07430-1623
US

IV. Provider business mailing address

505 RAMAPO VALLEY RD
MAHWAH NJ
07430-1623
US

V. Phone/Fax

Practice location:
  • Phone: 201-684-7536
  • Fax: 201-684-7534
Mailing address:
  • Phone: 201-684-7536
  • Fax: 201-684-7534

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NN05930100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: