Healthcare Provider Details

I. General information

NPI: 1174846786
Provider Name (Legal Business Name): MRS. DANIELE BASRALIAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2010
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 PROSPECT AVE
WEST ORANGE NJ
07052-4228
US

IV. Provider business mailing address

235 PROSPECT AVE
WEST ORANGE NJ
07052-4228
US

V. Phone/Fax

Practice location:
  • Phone: 973-766-9209
  • Fax:
Mailing address:
  • Phone: 973-766-9209
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number13422
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number28RI03417600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: