Provider Demographics
NPI:1801862537
Name:DEFEO, JANINE (CPNP)
Entity Type:Individual
Prefix:
First Name:JANINE
Middle Name:
Last Name:DEFEO
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 NEW PROVIDENCE RD
Mailing Address - Street 2:
Mailing Address - City:MOUNTAINSIDE
Mailing Address - State:NJ
Mailing Address - Zip Code:07092-2590
Mailing Address - Country:US
Mailing Address - Phone:908-301-5570
Mailing Address - Fax:908-301-5456
Practice Address - Street 1:150 NEW PROVIDENCE RD
Practice Address - Street 2:
Practice Address - City:MOUNTAINSIDE
Practice Address - State:NJ
Practice Address - Zip Code:07092-2590
Practice Address - Country:US
Practice Address - Phone:908-301-5570
Practice Address - Fax:908-301-5456
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00028600363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7353830OtherCIGNA HEALTHCARE
NJP2948380OtherOXFORD HEALTH PLANS
NJ185972OtherAMERIGROUP
NJ2K3679OtherHEALTHNET
NJS51B01OtherEMPIRE
NJ221487148-027OtherQUALCARE