Provider Demographics
NPI:1588059711
Name:BOLANOS, HAYDE MARICRUZ (APN)
Entity type:Individual
Prefix:
First Name:HAYDE
Middle Name:MARICRUZ
Last Name:BOLANOS
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 1:606 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:PATERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07514-1916
Mailing Address - Country:US
Mailing Address - Phone:908-240-8142
Mailing Address - Fax:
Practice Address - Street 1:401 HOWE AVE APT A9
Practice Address - Street 2:
Practice Address - City:PASSAIC
Practice Address - State:NJ
Practice Address - Zip Code:07055-1925
Practice Address - Country:US
Practice Address - Phone:973-473-7200
Practice Address - Fax:973-472-7300
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-03
Last Update Date:2019-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00560700363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily