Provider Demographics
NPI:1558072553
Name:ADAMEK, CONNIE PUTRINO (NP)
Entity Type:Individual
Prefix:
First Name:CONNIE
Middle Name:PUTRINO
Last Name:ADAMEK
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:83 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:GLEN ROCK
Mailing Address - State:NJ
Mailing Address - Zip Code:07452-1836
Mailing Address - Country:US
Mailing Address - Phone:201-314-2747
Mailing Address - Fax:
Practice Address - Street 1:83 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:GLEN ROCK
Practice Address - State:NJ
Practice Address - Zip Code:07452-1836
Practice Address - Country:US
Practice Address - Phone:201-314-2747
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-09
Last Update Date:2022-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00710900363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health