Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | 26NN03577100 | NJ |
NPI | 1023109485 |
---|---|
Provider Name | Mrs. Virginia Azzariti |
First Address | Teaneck, NJ 07666 |
Second Address | Teaneck, NJ 07666 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/09/2006 |
Last Update Date | 18/01/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7922400 | (05) | NJ |