Healthcare Provider Details

I. General information

NPI: 1013928746
Provider Name (Legal Business Name): DIANA L. SPANGENBERG A.P.N.-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 07/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 ADP BLVD MEDICAL DEPARTMENT
ROSELAND NJ
07068-1728
US

IV. Provider business mailing address

1 ADP BLVD MEDICAL DEPARTMENT
ROSELAND NJ
07068-1728
US

V. Phone/Fax

Practice location:
  • Phone: 973-974-5901
  • Fax:
Mailing address:
  • Phone: 973-974-5901
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number26NJ00071800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: