Healthcare Provider Details

I. General information

NPI: 1548616030
Provider Name (Legal Business Name): ENTELA AHMETI APN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2016
Last Update Date: 01/08/2025
Certification Date: 01/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 W JIMMIE LEEDS RD FL 1
POMONA NJ
08240-9102
US

IV. Provider business mailing address

65 W JIMMIE LEEDS RD FL 1
POMONA NJ
08240-9102
US

V. Phone/Fax

Practice location:
  • Phone: 609-748-7089
  • Fax: 609-652-3460
Mailing address:
  • Phone: 609-748-7089
  • Fax: 609-652-3460

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number26NJ00639500
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number26NJ00639500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: