Provider Demographics
NPI:1194546630
Name:BAYONETA, DALE J (RN)
Entity type:Individual
Prefix:
First Name:DALE
Middle Name:J
Last Name:BAYONETA
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 E BROAD ST
Mailing Address - Street 2:
Mailing Address - City:BERGENFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07621-3003
Mailing Address - Country:US
Mailing Address - Phone:201-563-5349
Mailing Address - Fax:
Practice Address - Street 1:294 STATE STREET
Practice Address - Street 2:SUITE 1
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601
Practice Address - Country:US
Practice Address - Phone:201-488-7246
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-17
Last Update Date:2024-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR13631900163WP0000X
NJ26NJ15184200363LG0600X
NJ26NJ115184200363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163WP0000XNursing Service ProvidersRegistered NursePain Management
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology