Healthcare Provider Details

I. General information

NPI: 1568339497
Provider Name (Legal Business Name): ESJONA MIMINI AGNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/23/2025
Last Update Date: 10/23/2025
Certification Date: 10/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 VALLEY HEALTH PLZ
PARAMUS NJ
07652-3619
US

IV. Provider business mailing address

13-41 3RD ST
FAIR LAWN NJ
07410-1105
US

V. Phone/Fax

Practice location:
  • Phone: 201-447-8000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAG09250085
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: