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General NPI Number Information
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NPI Number | 1659749844
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Entity Type | Organization
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Legal Business Name | PASSAIC MEDICAL CARE INC
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Dates
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Enumeration Date | 09/04/2015
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Last Update Date | 09/04/2015
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Provider Practice Location Address
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Address Line | 1135 MAIN AVE SUITE 3
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City | CLIFTON
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State | NJ
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Zip | 07011-2353
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Country | US
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Telephone | 862-238-8181
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Fax | 862-238-8183
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Provider Business Mailing Address
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Address Line | 1135 MAIN AVE SUITE 3
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City | CLIFTON
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State | NJ
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Zip | 07011-2353
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Country | US
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Telephone | 862-238-8181
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Fax | 862-238-8183
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Authorized Official
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Title or Position | NURSE PRACTIONER
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Name | MRS. DANIELLE ELIZABETH MARCOTULLI
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Credential | APN
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Telephone | 862-238-8181
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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 | 26NJ00587800
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License Number State | NJ
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