Healthcare Provider Details

I. General information

NPI: 1891027264
Provider Name (Legal Business Name): AURORA DALISAY APN,C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/09/2010
Last Update Date: 02/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4522 KENNEDY BLVD
UNION CITY NJ
07087-8014
US

IV. Provider business mailing address

1 MYRTLE AVE
SECAUCUS NJ
07094-4126
US

V. Phone/Fax

Practice location:
  • Phone: 201-863-1797
  • Fax:
Mailing address:
  • Phone: 551-655-8686
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberNN112992
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: