Healthcare Provider Details

I. General information

NPI: 1720020225
Provider Name (Legal Business Name): DANNETTE ARBOLEDA-MARIN RNFA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2006
Last Update Date: 07/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

447 ROUTE 10 E STE 15
RANDOLPH NJ
07869-2132
US

IV. Provider business mailing address

447 ROUTE 10 EAST STE 15
RANDOLPH NJ
07869
US

V. Phone/Fax

Practice location:
  • Phone: 973-442-3016
  • Fax: 973-442-3017
Mailing address:
  • Phone: 973-442-3016
  • Fax: 973-442-3017

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number26NO09133100
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number26NJ00651900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: