Healthcare Provider Details

I. General information

NPI: 1821518978
Provider Name (Legal Business Name): LINDSAY RAVEENA VIRDEE CPNP-PC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2017
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

316 ORANGE RD
MONTCLAIR NJ
07042-4310
US

IV. Provider business mailing address

35 ASPEN DR
CEDAR GROVE NJ
07009-2304
US

V. Phone/Fax

Practice location:
  • Phone: 862-213-0769
  • Fax:
Mailing address:
  • Phone: 954-778-6314
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number26NJ15608100
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberF382815
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: