Healthcare Provider Details

I. General information

NPI: 1053024208
Provider Name (Legal Business Name): EDUARDO JAMISOLA PADILLA JR. RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/03/2023
Last Update Date: 01/03/2023
Certification Date: 01/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 MOUNT PROSPECT AVE APT 17B
NEWARK NJ
07104-2951
US

IV. Provider business mailing address

515 MOUNT PROSPECT AVE APT 17B
NEWARK NJ
07104-2951
US

V. Phone/Fax

Practice location:
  • Phone: 201-724-5582
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number26NR11537000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: