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General NPI Number Information
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NPI Number | 1053700633
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Entity Type | Individual
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Provider Name | HOMERO PANIAGUA APN
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Gender | Male
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Dates
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Enumeration Date | 01/20/2015
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Last Update Date | 01/20/2015
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Provider Practice Location Address
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Address Line | 1001 PLEASANT VALLEY WAY
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City | WEST ORANGE
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State | NJ
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Zip | 07052
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Country | US
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Telephone | 973-669-8448
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Fax | 973-669-9536
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Provider Business Mailing Address
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Address Line | 375 MOUNT PLEASANT AVENUE SUITE 250
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City | WEST ORANGE
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State | NJ
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Zip | 07052
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Country | US
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Telephone | 973-323-1320
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Fax | 973-323-1347
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 26NJ00548000
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License Number State | NJ
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