Healthcare Provider Details

I. General information

NPI: 1144986092
Provider Name (Legal Business Name): FREDERICK DOLAN APN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2021
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 STATE ROUTE 35
CLIFFWOOD NJ
07721-1512
US

IV. Provider business mailing address

111 STATE ROUTE 35
CLIFFWOOD NJ
07721-1512
US

V. Phone/Fax

Practice location:
  • Phone: 732-812-5489
  • Fax: 732-812-5489
Mailing address:
  • Phone: 732-812-5489
  • Fax: 732-812-5489

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number26NJ01229800
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ01229800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: