Healthcare Provider Details

I. General information

NPI: 1285946012
Provider Name (Legal Business Name): DIANE STOLLER R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2010
Last Update Date: 07/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

336 W PASSAIC ST 2ND FL
ROCHELLE PARK NJ
07662-3027
US

IV. Provider business mailing address

336 W PASSAIC ST 2ND FL
ROCHELLE PARK NJ
07662-3027
US

V. Phone/Fax

Practice location:
  • Phone: 201-845-7030
  • Fax: 201-845-0899
Mailing address:
  • Phone: 201-845-7030
  • Fax: 201-845-0899

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number61538
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: