Healthcare Provider Details

I. General information

NPI: 1588814743
Provider Name (Legal Business Name): CATHERINE STANZIONE A.P.N.,C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2008
Last Update Date: 03/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 PASSAIC AVE
SPRING LAKE NJ
07762-1308
US

IV. Provider business mailing address

120 PASSAIC AVE
SPRING LAKE NJ
07762-1308
US

V. Phone/Fax

Practice location:
  • Phone: 732-282-1816
  • Fax: 732-282-9112
Mailing address:
  • Phone: 732-282-1816
  • Fax: 732-282-9112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number26NO03891300
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code163WC1400X
TaxonomyCollege Health Registered Nurse
License Number26NO03891300
License Number StateNJ
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ00175300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: