Healthcare Provider Details

I. General information

NPI: 1295388056
Provider Name (Legal Business Name): LAURA O'REILLY-STANZILIS R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2019
Last Update Date: 07/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 WILLOW STREET
MOUNT ARLINGTON NJ
07856
US

IV. Provider business mailing address

31 WILLOW STREET
MOUNT ARLINGTON NJ
07856
US

V. Phone/Fax

Practice location:
  • Phone: 646-251-6444
  • Fax:
Mailing address:
  • Phone: 646-251-6444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number26NR14675200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: