Basic Information
Provider Information | |||||||||
NPI: | 1689817652 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | PIERREPIERRE | ||||||||
FirstName: | DARLENE | ||||||||
MiddleName: | D | ||||||||
NamePrefix: | MRS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | PA-C | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | DAYE | ||||||||
OtherFirstName: | DARLENE | ||||||||
OtherMiddleName: | C. | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 695 US HIGHWAY 46 | ||||||||
Address2: | STE 400A | ||||||||
City: | FAIRFIELD | ||||||||
State: | NJ | ||||||||
PostalCode: | 070041568 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9738941265 | ||||||||
FaxNumber: | 9738946480 | ||||||||
Practice Location | |||||||||
Address1: | 695 US HIGHWAY 46 STE 400A | ||||||||
Address2: |   | ||||||||
City: | FAIRFIELD | ||||||||
State: | NJ | ||||||||
PostalCode: | 070041568 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9738268080 | ||||||||
FaxNumber: | 8883093354 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 04/07/2009 | ||||||||
LastUpdateDate: | 03/17/2018 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | MA053338 | PA | N |   | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |   | 363AS0400X | 25MP00198900 | NJ | Y |   | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical |
ID Information
ID | Type | State | Issuer | Description | 583000YP69 | 01 | NJ | QSS PTAN | OTHER | 583001ZJ5N | 01 | NJ | SSL PTAN | OTHER | MP1900794 | 01 |   | DEA REGISTRATION NUMBER | OTHER |