Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Miriam Kerolus Fanouse

Individual provider Student in an Organized Health Care Education/Training Program · NPI 1356761456

Miriam Kerolus Fanouse is a Student in an Organized Health Care Education/Training Program in Warren, New Jersey. Works from 2 locations. Licensed in New Jersey.

Licensed in
NJ
In the registry since
2014
Specialties on file
2

Practice location Address checks out

34 Mountain Blvd
Warren, NJ 07059-2640
Phone: (347) 307-1381
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 4802 10th Ave, Brooklyn, NY 11219-2916 — (718) 283-6000

Specialties & licences

Dentist (primary) Taxonomy 122300000X · Licence 22DI02942100 (NJ)
Student in an Organized Health Care Education/Training Program Taxonomy 390200000X

Record details

NPI number1356761456
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorNo
NPI enumeratedApril 16, 2014
Last updated in NPPESMarch 5, 2025
Certification dateMarch 5, 2025

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