Healthcare Provider Details

I. General information

NPI: 1417064064
Provider Name (Legal Business Name): RITA DESSAU APNC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

100 MADISON AVE
MORRISTOWN NJ
07960-6136
US

IV. Provider business mailing address

128 MOUNTAINVIEW AVENUE
NUTLEY NJ
07110-0223
US

V. Phone/Fax

Practice location:
  • Phone: 973-971-5305
  • Fax: 973-290-7172
Mailing address:
  • Phone: 973-661-1033
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number26NC04362000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: