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General NPI Number Information
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NPI Number | 1235629247
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Entity Type | Individual
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Provider Name | ILANA STACEY CAPOZZI APN
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Gender | Female
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Dates
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Enumeration Date | 05/15/2018
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Last Update Date | 07/26/2022
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Provider Practice Location Address
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Address Line | 40 WASHINGTON AVE
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City | DUMONT
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State | NJ
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Zip | 07628-3697
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Country | US
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Telephone | 201-387-7055
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Fax |
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Provider Business Mailing Address
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Address Line | 10 ECHO HILL RD
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City | MONTVALE
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State | NJ
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Zip | 07645-2407
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Country | US
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Telephone | 201-694-4967
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Fax |
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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 | 26NJ00823300
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License Number State | NJ
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