Healthcare Provider Details

I. General information

NPI: 1528794195
Provider Name (Legal Business Name): CLAIRE ANNIA DATUS APN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2022
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 FOREST AVE STE 201
PARAMUS NJ
07652-5246
US

IV. Provider business mailing address

4 FOREST AVE STE 201
PARAMUS NJ
07652-5246
US

V. Phone/Fax

Practice location:
  • Phone: 201-565-2920
  • Fax:
Mailing address:
  • Phone: 201-565-2920
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number26NJ01342800
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number26NJ01342800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: