Healthcare Provider Details

I. General information

NPI: 1205767829
Provider Name (Legal Business Name): MIREYA PAZMINO APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2026
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

887 KINDERKAMACK RD STE 2
RIVER EDGE NJ
07661-2307
US

IV. Provider business mailing address

887 KINDERKAMACK RD STE 2
RIVER EDGE NJ
07661-2307
US

V. Phone/Fax

Practice location:
  • Phone: 201-464-0860
  • Fax: 888-440-2752
Mailing address:
  • Phone: 201-464-0860
  • Fax: 888-440-2752

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number26NJ15557600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: