Provider Demographics
NPI:1023109485
Name:AZZARITI, VIRGINIA (CPNP)
Entity type:Individual
Prefix:MRS
First Name:VIRGINIA
Middle Name:
Last Name:AZZARITI
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 1:870 PALISADE AVENUE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666
Mailing Address - Country:US
Mailing Address - Phone:201-692-1661
Mailing Address - Fax:201-692-9219
Practice Address - Street 1:870 PALISADE AVENUE
Practice Address - Street 2:SUITE 201
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666
Practice Address - Country:US
Practice Address - Phone:201-692-1661
Practice Address - Fax:201-692-9219
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2013-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NN03577100363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7922400Medicaid