Healthcare Provider Details

I. General information

NPI: 1194569137
Provider Name (Legal Business Name): CHRISTOPHER OWENDOFF RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2024
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

351 EVELYN ST FL 3
PARAMUS NJ
07652-2901
US

IV. Provider business mailing address

324 DANIELE DR
OCEAN NJ
07712-7908
US

V. Phone/Fax

Practice location:
  • Phone: 201-977-2889
  • Fax:
Mailing address:
  • Phone: 732-832-6388
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number26NJ15591700
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number26NR24438500
License Number StateNJ
# 3
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number937559
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: