Healthcare Provider Details

I. General information

NPI: 1275351843
Provider Name (Legal Business Name): EFRAIN OLIVERAS APN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2024
Last Update Date: 06/30/2025
Certification Date: 06/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 ENGLE ST 5 MAIN
ENGLEWOOD NJ
07631-1898
US

IV. Provider business mailing address

206A WALNUT ST
NORTHVALE NJ
07647-2009
US

V. Phone/Fax

Practice location:
  • Phone: 201-894-3636
  • Fax:
Mailing address:
  • Phone: 917-647-1469
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number26NJ15134000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: