Provider Demographics
NPI:1780270355
Name:PLITTMAN, AVIVA (FNP)
Entity type:Individual
Prefix:
First Name:AVIVA
Middle Name:
Last Name:PLITTMAN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 ESSEX ST
Mailing Address - Street 2:
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-8550
Mailing Address - Country:US
Mailing Address - Phone:201-646-0110
Mailing Address - Fax:
Practice Address - Street 1:360 ESSEX ST
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-8550
Practice Address - Country:US
Practice Address - Phone:201-646-0110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-17
Last Update Date:2021-03-22
Deactivation Date:2021-01-14
Deactivation Code:
Reactivation Date:2021-02-09
Provider Licenses
StateLicense IDTaxonomies
NJ26NR15692400163W00000X
NJ26NJ01102400363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
4711633OtherHEALTHCARE PROVIDER