Healthcare Provider Details

I. General information

NPI: 1154536399
Provider Name (Legal Business Name): GERALDINE VARGAS APN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 PROSPECT AVE ETD OFFICE 3 MAIN RM 3624
HACKENSACK NJ
07601-1914
US

IV. Provider business mailing address

444 PIERMONT RD
DEMAREST NJ
07627-2421
US

V. Phone/Fax

Practice location:
  • Phone: 201-996-3192
  • Fax: 201-968-1866
Mailing address:
  • Phone: 201-996-5181
  • Fax: 201-996-4239

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberNR71552
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: