Healthcare Provider Details

I. General information

NPI: 1447154489
Provider Name (Legal Business Name): DEAN YOUNES DRIDI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CAPITAL WAY
PENNINGTON NJ
08534-2520
US

IV. Provider business mailing address

49 E HANCOCK ST
RIVERSIDE NJ
08075-3606
US

V. Phone/Fax

Practice location:
  • Phone: 800-637-2374
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number26NR24790300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: