Healthcare Provider Details

I. General information

NPI: 1720756331
Provider Name (Legal Business Name): IRENA CYCYLIA JANIEC-ZITO APN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2021
Last Update Date: 08/31/2021
Certification Date: 08/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

563 W SADDLE RIVER RD
UPPER SADDLE RIVER NJ
07458-1112
US

IV. Provider business mailing address

563 W SADDLE RIVER RD
UPPER SADDLE RIVER NJ
07458-1112
US

V. Phone/Fax

Practice location:
  • Phone: 201-966-9086
  • Fax:
Mailing address:
  • Phone: 201-966-9086
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ01152000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: