Healthcare Provider Details

I. General information

NPI: 1568324135
Provider Name (Legal Business Name): ATALIE JEROME
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2025
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1404 GUSTAV AVE
UNION NJ
07083-6237
US

IV. Provider business mailing address

1404 GUSTAV AVE
UNION NJ
07083-6237
US

V. Phone/Fax

Practice location:
  • Phone: 908-884-5428
  • Fax:
Mailing address:
  • Phone: 908-884-5428
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number26NP05183200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: