Provider Demographics
NPI:1427426006
Name:VALLONE, THERESA MAE (APN)
Entity type:Individual
Prefix:MRS
First Name:THERESA
Middle Name:MAE
Last Name:VALLONE
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:157 VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:HAWORTH
Mailing Address - State:NJ
Mailing Address - Zip Code:07641-1821
Mailing Address - Country:US
Mailing Address - Phone:201-575-2224
Mailing Address - Fax:
Practice Address - Street 1:157 VALLEY RD
Practice Address - Street 2:
Practice Address - City:HAWORTH
Practice Address - State:NJ
Practice Address - Zip Code:07641-1821
Practice Address - Country:US
Practice Address - Phone:201-575-2224
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-13
Last Update Date:2015-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00580500363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ26NJ00580500OtherLICENSE NUMBER