Basic Information
| Provider Information | |||||||||
| NPI: | 1972016301 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KAKOLEWSKI | ||||||||
| FirstName: | ASHLEN | ||||||||
| MiddleName: | MICHAL | ||||||||
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| Credential: | FNP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 920 W SADDLE RIVER RD | ||||||||
| Address2: | |||||||||
| City: | HO HO KUS | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 074231208 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7039194209 | ||||||||
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| Practice Location | |||||||||
| Address1: | 19-21 FAIR LAWN AVE # 725 | ||||||||
| Address2: | |||||||||
| City: | FAIR LAWN | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 074102331 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9082734300 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/07/2017 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 26NJ00777200 | NJ | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | 363LF0000X | 26NJ00777200 | NJ | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.