=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669356853
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ERIC ANTHONY MALDONADO DNP, APN, AGACNP-BC
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/01/2025
-----------------------------------------------------
Last Update Date | 08/01/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 350 ENGLE ST
-----------------------------------------------------
City | ENGLEWOOD
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07631-1808
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-894-3000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 297 PALISADE AVE APT 504
-----------------------------------------------------
City | BOGOTA
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07603-1381
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-268-0932
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LA2100X
-----------------------------------------------------
Taxonomy Name | Acute Care Nurse Practitioner
-----------------------------------------------------
License Number | 26NJ15376700
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------