Provider Demographics
NPI:1942511688
Name:FAULKNER, ADRIANA DANIELLE (MD)
Entity Type:Individual
Prefix:DR
First Name:ADRIANA
Middle Name:DANIELLE
Last Name:FAULKNER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ADRIANA
Other - Middle Name:FAULKNER
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:130 KINDERKAMACK RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:RIVER EDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07661-1939
Mailing Address - Country:US
Mailing Address - Phone:201-488-2660
Mailing Address - Fax:201-489-2812
Practice Address - Street 1:30 PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-1915
Practice Address - Country:US
Practice Address - Phone:551-996-2200
Practice Address - Fax:201-489-2812
Is Sole Proprietor?:No
Enumeration Date:2010-06-28
Last Update Date:2016-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA099083002085R0202X
CAA1195812085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0500038Medicaid
NJ0500038Medicaid
CACB253859Medicare PIN
CACB253857Medicare PIN
NJ513994TE0Medicare PIN