Healthcare Provider Details

I. General information

NPI: 1275907412
Provider Name (Legal Business Name): MAHALIA VANDERPUIJE DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/27/2015
Last Update Date: 11/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3799 ROUTE 46 SUITE 211
PARSIPPANY NJ
07054-1055
US

IV. Provider business mailing address

3799 ROUTE 46 SUITE 211
PARSIPPANY NJ
07054-1055
US

V. Phone/Fax

Practice location:
  • Phone: 201-993-0763
  • Fax:
Mailing address:
  • Phone: 201-993-0763
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number041402342
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: