Healthcare Provider Details

I. General information

NPI: 1740348580
Provider Name (Legal Business Name): ADRIANA ACKERMAN ANCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 VERONICA AVE SUITE 204
SOMERSET NJ
08873-5002
US

IV. Provider business mailing address

75 VERONICA AVE SUITE 204
SOMERSET NJ
08873-5002
US

V. Phone/Fax

Practice location:
  • Phone: 732-828-0002
  • Fax: 732-828-7070
Mailing address:
  • Phone: 732-828-0002
  • Fax: 732-828-7070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number2006010102-21
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: