Healthcare Provider Details

I. General information

NPI: 1750133039
Provider Name (Legal Business Name): PADAMA MISRA AGNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2024
Last Update Date: 06/26/2025
Certification Date: 06/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28 VALLEY RD # 148
MONTCLAIR NJ
07042-2709
US

IV. Provider business mailing address

1 OAKEY DR
KENDALL PARK NJ
08824-1625
US

V. Phone/Fax

Practice location:
  • Phone: 973-559-4600
  • Fax: 855-998-4358
Mailing address:
  • Phone: 917-617-5488
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number26NJ15009300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: