Healthcare Provider Details

I. General information

NPI: 1780354563
Provider Name (Legal Business Name): JOCELYN PATRICIA MARIANI FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JOCELYN PATRICIA MARIANI

II. Dates (important events)

Enumeration Date: 09/14/2021
Last Update Date: 12/07/2021
Certification Date: 12/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 MOONACHIE RD STE 100
MOONACHIE NJ
07074-1322
US

IV. Provider business mailing address

112 PORTSIDE DR
EDGEWATER NJ
07020-1147
US

V. Phone/Fax

Practice location:
  • Phone: 201-596-6262
  • Fax:
Mailing address:
  • Phone: 518-605-4214
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ01202400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: