Basic Information
| Provider Information | |||||||||
| NPI: | 1952060923 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FARAGASSO | ||||||||
| FirstName: | LINDA | ||||||||
| MiddleName: | L | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | APN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 301 LIPPINCOTT DR STE 410 | ||||||||
| Address2: | |||||||||
| City: | MARLTON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080534197 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6098223027 | ||||||||
| FaxNumber: | 6098225195 | ||||||||
| Practice Location | |||||||||
| Address1: | 6508 VENTNOR AVE | ||||||||
| Address2: | |||||||||
| City: | VENTNOR CITY | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 084062177 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6098223027 | ||||||||
| FaxNumber: | 6098225195 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/16/2021 | ||||||||
| LastUpdateDate: | 07/12/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 07/12/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 26NJ01222100 | NJ | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.