Healthcare Provider Details

I. General information

NPI: 1851202311
Provider Name (Legal Business Name): JUSTYNA ANETA SUROWANIEC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 BOULEVARD
PASSAIC NJ
07055-2840
US

IV. Provider business mailing address

32 GARDEN CT N
GARFIELD NJ
07026-2312
US

V. Phone/Fax

Practice location:
  • Phone: 973-365-4300
  • Fax:
Mailing address:
  • Phone: 201-270-7225
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ15559800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: