Healthcare Provider Details

I. General information

NPI: 1649014937
Provider Name (Legal Business Name): DANA BOCCELLARI APN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2024
Last Update Date: 10/13/2024
Certification Date: 10/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 FRANKLIN TPKE
WALDWICK NJ
07463-1847
US

IV. Provider business mailing address

140 FRANKLIN TPKE STE 6A
WALDWICK NJ
07463-1836
US

V. Phone/Fax

Practice location:
  • Phone: 201-447-3603
  • Fax:
Mailing address:
  • Phone: 201-447-3603
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ15118200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: