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General NPI Number Information
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NPI Number | 1285795468
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Entity Type | Individual
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Provider Name | MARLISSA M BELAY APN
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Gender | Female
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Dates
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Enumeration Date | 12/12/2006
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Last Update Date | 09/09/2016
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Provider Practice Location Address
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Address Line | 78 WILLOWDALE AVE
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City | MONTCLAIR
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State | NJ
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Zip | 07042-4423
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Country | US
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Telephone | 732-442-8185
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Fax | 732-442-8188
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Provider Business Mailing Address
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Address Line | 78 WILLOWDALE AVE
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City | MONTCLAIR
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State | NJ
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Zip | 07042-4423
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Country | US
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Telephone | 732-442-8185
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 26NJ00048100
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License Number State | NJ
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