Healthcare Provider Details

I. General information

NPI: 1871597476
Provider Name (Legal Business Name): MEGHAN E CLEMENTE ANP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MEGHAN E MCGANN ANP-C

II. Dates (important events)

Enumeration Date: 06/10/2005
Last Update Date: 05/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1270 HIGHWAY 35
MIDDLETOWN NJ
07748
US

IV. Provider business mailing address

1270 HIGHWAY 35
MIDDLETOWN NJ
07748-2014
US

V. Phone/Fax

Practice location:
  • Phone: 732-615-3900
  • Fax: 732-615-0185
Mailing address:
  • Phone: 732-615-3900
  • Fax: 732-615-0865

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number26NN09409300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: