=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073786737
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOSEFINA GREGORY ADV. PRACTICE RN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/02/2008
-----------------------------------------------------
Last Update Date | 01/20/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 261 JAMES ST STE 1G
-----------------------------------------------------
City | MORRISTOWN
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07960-6348
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-540-9393
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 49 CHARNWOOD RD
-----------------------------------------------------
City | NEW PROVIDENCE
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07974-1768
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 908-508-1344
-----------------------------------------------------
Fax | 908-508-0033
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0200X
-----------------------------------------------------
Taxonomy Name | Pediatric Nurse Practitioner
-----------------------------------------------------
License Number | 26NJ00000100
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------