Healthcare Provider Details

I. General information

NPI: 1518937994
Provider Name (Legal Business Name): VICTORIA ELLEN EFTYCHIOU RN, APN, C
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 S ORANGE AVE
SOUTH ORANGE NJ
07079-2646
US

IV. Provider business mailing address

15 BROOK AVE
MONTVALE NJ
07645-2101
US

V. Phone/Fax

Practice location:
  • Phone: 973-761-9175
  • Fax:
Mailing address:
  • Phone: 201-391-9841
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number26NN07903400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: