Provider Demographics
NPI:1336136688
Name:HOTTENSTEIN, CHERYL (APN BC)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:
Last Name:HOTTENSTEIN
Suffix:
Gender:F
Credentials:APN BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:741 NORTHFIELD AVE
Mailing Address - Street 2:SUTIE 205
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-1174
Mailing Address - Country:US
Mailing Address - Phone:973-467-1544
Mailing Address - Fax:973-467-9586
Practice Address - Street 1:741 NORTHFIELD AVE
Practice Address - Street 2:SUTIE 205
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052-1174
Practice Address - Country:US
Practice Address - Phone:973-467-1544
Practice Address - Fax:973-467-9586
Is Sole Proprietor?:No
Enumeration Date:2005-10-03
Last Update Date:2014-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00019900363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ072623AZBMedicare ID - Type Unspecified
P96648Medicare UPIN