MEDICARE: LINDA LOGANG NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	26NJ00281500	NJ

General Provider Information

NPI Number	:	1730469081
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LINDA LOGANG NP

Provider Business Mailing Address
First Line	:	18-20 LACKAWANNA PLZ STE 300
Second Line	:
City	:	MONTCLAIR
State	:	NJ
Zip	:	07042-3642
Country	:	US
Telephone Number	:	347-209-0881
Fax Number	:	973-869-2532

Provider Business Practice Location Address
First Line	:	18-20 LACKAWANNA PLZ STE 300
Second Line	:
City	:	MONTCLAIR
State	:	NJ
Zip	:	07042-3642
Country	:	US
Telephone Number	:	347-209-0881
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/18/2011
Last Update Date	:	04/28/2025

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Directions to “ LINDA LOGANG NP” Practice Location

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