Basic Information
| Provider Information | |||||||||
| NPI: | 1235127309 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CIMORELLI | ||||||||
| FirstName: | MONIQUE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | N.P | ||||||||
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| Mailing Information | |||||||||
| Address1: | 125 E FRANKLIN AVE | ||||||||
| Address2: | |||||||||
| City: | EDGEWATER PARK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080101846 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6096058035 | ||||||||
| FaxNumber: | 6095265799 | ||||||||
| Practice Location | |||||||||
| Address1: | 680 BLAIR MILL RD | ||||||||
| Address2: | |||||||||
| City: | HORSHAM | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190442223 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8662979232 | ||||||||
| FaxNumber: | 8888168109 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/12/2005 | ||||||||
| LastUpdateDate: | 05/12/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 26NN10761400 | NJ | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 7748604 | 05 | NJ | MEDICAID |