Basic Information
| Provider Information | |||||||||
| NPI: | 1932379427 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JOLIN | ||||||||
| FirstName: | MEGAN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 40 VALLEY RD | ||||||||
| Address2: | |||||||||
| City: | GLEN ROCK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 074521712 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2019622392 | ||||||||
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| Practice Location | |||||||||
| Address1: | 30 PROSPECT AVE | ||||||||
| Address2: | |||||||||
| City: | HACKENSACK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 076011915 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5519965430 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/11/2008 | ||||||||
| LastUpdateDate: | 09/22/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/18/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0200X | 26NJ00111900 | NJ | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Pediatrics |
No ID Information.