PRODIGY AESTHETICS NPI 1437856648

NPI Information

NPI: 1437856648
Provider Name: PRODIGY AESTHETICS
Classification: Nurse Practitioner - 363LP2300X
Specialization: Primary Care
Entity Type: Organization
Doing Business As: PRODIGY AESTHETICS AND PRIMARY CARE
CLIA Number: 31D2276707
Address: 680 BROADWAY STE 205
PATERSON, NJ
ZIP 07514
Phone: (973) 790-0123

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NPI Details

PRODIGY AESTHETICS is a primary care nurse practitioner in Paterson, NJ. PRODIGY AESTHETICS NPI is 1437856648. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Is Doing Business As Prodigy Aesthetics And Primary Care.

The provider's business location address is:

680 BROADWAY STE 205
PATERSON, NJ
ZIP 07514-527
Phone: (973) 790-0123

The provider's authorized official is Carolyn Cedeno .
The authorized official title is Owner and has the following contact phone number (973) 221-5527.

The CLIA number assigned to this NPI record is 31D2276707 - practitioner other with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 2/8/2023 and was last updated on 3/8/2023.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363LP2300X	Nurse Practitioner	Primary Care			Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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