=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083817233
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOANNE AFFINITO RN, MSN, APRN, BC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/06/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 20 BROWNSTONE TER
-----------------------------------------------------
City | HAWTHORNE
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07506-3447
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-602-8374
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 20 BROWNSTONE TER
-----------------------------------------------------
City | HAWTHORNE
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07506-3447
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-602-8374
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LA2200X
-----------------------------------------------------
Taxonomy Name | Adult Health Nurse Practitioner
-----------------------------------------------------
License Number | 26NN04855100
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------