Provider Demographics
NPI:1720020225
Name:ARBOLEDA-MARIN, DANNETTE (RNFA)
Entity Type:Individual
Prefix:
First Name:DANNETTE
Middle Name:
Last Name:ARBOLEDA-MARIN
Suffix:
Gender:F
Credentials:RNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:447 ROUTE 10 EAST STE 15
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:NJ
Mailing Address - Zip Code:07869
Mailing Address - Country:US
Mailing Address - Phone:973-442-3016
Mailing Address - Fax:973-442-3017
Practice Address - Street 1:447 ROUTE 10 E STE 15
Practice Address - Street 2:
Practice Address - City:RANDOLPH
Practice Address - State:NJ
Practice Address - Zip Code:07869-2132
Practice Address - Country:US
Practice Address - Phone:973-442-3016
Practice Address - Fax:973-442-3017
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-11
Last Update Date:2017-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NO09133100163WR0006X
NJ26NJ00651900207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First AssistantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ26NO09133100OtherLICENSE