Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | 26NJ00185800 | NJ |
NPI | 1013157791 |
---|---|
Provider Name | Mr. Michael Pasquale |
First Address | Nutley, NJ 07110-2234 |
Second Address | Paterson, NJ 07503-2621 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/02/2009 |
Last Update Date | 01/09/2021 |