Healthcare Provider Details

I. General information

NPI: 1205744323
Provider Name (Legal Business Name): MARYERLL SOCORRO TEVES APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 BEAUVOIR AVE
SUMMIT NJ
07901-3533
US

IV. Provider business mailing address

87 ADAMS ST
ISELIN NJ
08830-1343
US

V. Phone/Fax

Practice location:
  • Phone: 908-522-2929
  • Fax:
Mailing address:
  • Phone: 917-345-2682
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number26NJ15642100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: