Healthcare Provider Details

I. General information

NPI: 1205905809
Provider Name (Legal Business Name): LORETTA M NINIVAGGI RN, APN,C CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 07/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2240 STATE ROUTE 33
NEPTUNE NJ
07753-6110
US

IV. Provider business mailing address

2240 STATE ROUTE 33
NEPTUNE NJ
07753-6110
US

V. Phone/Fax

Practice location:
  • Phone: 732-897-3980
  • Fax: 732-897-3982
Mailing address:
  • Phone: 732-897-3980
  • Fax: 732-897-3982

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number26NJ00067000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: