Provider Demographics
NPI:1710726054
Name:MODAN, FALAKNAZ I (BSN, RN, FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:FALAKNAZ
Middle Name:I
Last Name:MODAN
Suffix:
Gender:F
Credentials:BSN, RN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 COLTS RUN RD
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540-8594
Mailing Address - Country:US
Mailing Address - Phone:732-595-6940
Mailing Address - Fax:
Practice Address - Street 1:1371 SEABURY AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-3651
Practice Address - Country:US
Practice Address - Phone:718-294-6200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-24
Last Update Date:2024-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ15073200363LF0000X
NJ26NR16916300163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse