=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245679869
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MRS. SHAFIQA POPAL
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/17/2013
-----------------------------------------------------
Last Update Date | 09/19/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 65 JAMES ST
-----------------------------------------------------
City | EDISON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08820-3947
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-321-7010
-----------------------------------------------------
Fax | 732-654-1584
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 331 NEWMAN SPRINGS RD STE 220
-----------------------------------------------------
City | RED BANK
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07701-5792
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-807-0877
-----------------------------------------------------
Fax | 201-751-1680
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 364SA2200X
-----------------------------------------------------
Taxonomy Name | Adult Health Clinical Nurse Specialist
-----------------------------------------------------
License Number | 26NJ15002200
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 364SA2200X
-----------------------------------------------------
Taxonomy Name | Adult Health Clinical Nurse Specialist
-----------------------------------------------------
License Number | NP23130
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------