Healthcare Provider Details

I. General information

NPI: 1063066827
Provider Name (Legal Business Name): KELLY RUMLER APN-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2019
Last Update Date: 10/16/2023
Certification Date: 10/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

223 N VAN DIEN AVE
RIDGEWOOD NJ
07450-2736
US

IV. Provider business mailing address

1 SEARS DR STE 306
PARAMUS NJ
07652-3510
US

V. Phone/Fax

Practice location:
  • Phone: 201-447-8000
  • Fax:
Mailing address:
  • Phone: 201-830-2287
  • Fax: 201-830-2286

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number26NJ00940500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: