Healthcare Provider Details

I. General information

NPI: 1265124085
Provider Name (Legal Business Name): CAROLINE ANN SCHADE AGNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2023
Last Update Date: 12/28/2023
Certification Date: 12/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1415 QUEEN ANNE RD
TEANECK NJ
07666-3521
US

IV. Provider business mailing address

4 MARCOTTE LN
BERGENFIELD NJ
07621-3209
US

V. Phone/Fax

Practice location:
  • Phone: 201-837-7788
  • Fax:
Mailing address:
  • Phone: 201-881-6545
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number26NJ01436800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: