Provider Demographics
NPI:1043945322
Name:WALIGROSKI, DYLAN JOHN (MSN, RN, APN, FNP-C)
Entity Type:Individual
Prefix:
First Name:DYLAN
Middle Name:JOHN
Last Name:WALIGROSKI
Suffix:
Gender:M
Credentials:MSN, RN, APN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12I BROOKSIDE HTS
Mailing Address - Street 2:
Mailing Address - City:WANAQUE
Mailing Address - State:NJ
Mailing Address - Zip Code:07465-1630
Mailing Address - Country:US
Mailing Address - Phone:973-897-2720
Mailing Address - Fax:
Practice Address - Street 1:30 PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-1915
Practice Address - Country:US
Practice Address - Phone:551-996-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-20
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY832643163W00000X
NJ26NR18929100163W00000X
NY350777363L00000X
NJ26NJ01342100363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse