Healthcare Provider Details

I. General information

NPI: 1730292269
Provider Name (Legal Business Name): INA E WOMBLE APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: INA E TRIANO APN

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 CENTURY DR
PARSIPPANY NJ
07054-4610
US

IV. Provider business mailing address

456 PORT MONMOUTH RD E
PORT MONMOUTH NJ
07758-1646
US

V. Phone/Fax

Practice location:
  • Phone: 877-692-4665
  • Fax:
Mailing address:
  • Phone: 732-787-9277
  • Fax: 612-659-7101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number333340-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NC08044100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: