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General NPI Number Information
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NPI Number | 1528476686
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Entity Type | Individual
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Provider Name | JACQUELINE DECUNZO ANP
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Gender | Female
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Dates
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Enumeration Date | 07/31/2014
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Last Update Date | 09/04/2025
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Provider Practice Location Address
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Address Line | 1 GATEWAY CTR STE 2600
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City | NEWARK
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State | NJ
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Zip | 07102-5323
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Country | US
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Telephone | 888-731-8994
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Fax |
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Provider Business Mailing Address
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Address Line | 903 BOND ST
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City | ASBURY PARK
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State | NJ
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Zip | 07712-5903
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Country | US
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Telephone | 518-796-1399
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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 | 306928
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License Number State | NY
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