MEDICARE: ELIZABETH ANNE BENNETT-GARGUILO FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	735422	NY
2	363LF0000X	Family Nurse Practitioner	26NJ14892400	NJ
3	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	407509	NY
4	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	26NJ14892400	NJ
5	363LF0000X	Family Nurse Practitioner	351663	NY
6	163W00000X	Registered Nurse	26NR19772700	NJ

General Provider Information

NPI Number	:	1225716426
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH ANNE BENNETT-GARGUILO FNP

Provider Business Mailing Address
First Line	:	133 HARRISON AVE
Second Line	:
City	:	WESTFIELD
State	:	NJ
Zip	:	07090-2432
Country	:	US
Telephone Number	:	908-803-0361
Fax Number	:

Provider Business Practice Location Address
First Line	:	133 HARRISON AVE
Second Line	:
City	:	WESTFIELD
State	:	NJ
Zip	:	07090-2432
Country	:	US
Telephone Number	:	908-803-0361
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2023
Last Update Date	:	01/07/2026

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