Provider Demographics
NPI:1861678716
Name:PATERNOSTRO, INA (APN, BC, FNP)
Entity Type:Individual
Prefix:
First Name:INA
Middle Name:
Last Name:PATERNOSTRO
Suffix:
Gender:F
Credentials:APN, BC, FNP
Other - Prefix:
Other - First Name:INA
Other - Middle Name:
Other - Last Name:PATERNOSTRO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:333 FORSGATE DR
Mailing Address - Street 2:SUITE 205
Mailing Address - City:JAMESBURG
Mailing Address - State:NJ
Mailing Address - Zip Code:08831-1567
Mailing Address - Country:US
Mailing Address - Phone:732-521-1210
Mailing Address - Fax:
Practice Address - Street 1:333 FORSGATE DR
Practice Address - Street 2:SUITE 205
Practice Address - City:JAMESBURG
Practice Address - State:NJ
Practice Address - Zip Code:08831-1567
Practice Address - Country:US
Practice Address - Phone:732-521-1210
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-10
Last Update Date:2013-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00142200363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ124019XVAMedicare UPIN