Healthcare Provider Details

I. General information

NPI: 1659803138
Provider Name (Legal Business Name): ALLISON NICOLE DIANGELO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2017
Last Update Date: 07/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1578 RTE 23
WAYNE NJ
07470
US

IV. Provider business mailing address

1578 RTE 23
WAYNE NJ
07470-7516
US

V. Phone/Fax

Practice location:
  • Phone: 973-706-0238
  • Fax:
Mailing address:
  • Phone: 973-706-0238
  • Fax: 973-832-4925

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ00720300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: