Provider Demographics
NPI:1548781040
Name:FATTAL, NATALIE (APN)
Entity Type:Individual
Prefix:MRS
First Name:NATALIE
Middle Name:
Last Name:FATTAL
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:731 EWING AVE
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN LAKES
Mailing Address - State:NJ
Mailing Address - Zip Code:07417-2228
Mailing Address - Country:US
Mailing Address - Phone:201-835-3666
Mailing Address - Fax:
Practice Address - Street 1:194 BROAD ST # 4
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07003-2606
Practice Address - Country:US
Practice Address - Phone:973-680-8400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-05
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00738700363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner