Healthcare Provider Details

I. General information

NPI: 1265775134
Provider Name (Legal Business Name): ADAM CRAIG GANZMAN FNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2013
Last Update Date: 04/21/2020
Certification Date: 04/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 BEAUVOIR AVE OUTPATIENT NEUROLOGY
SUMMIT NJ
07901-3577
US

IV. Provider business mailing address

PO BOX 416457
BOSTON MA
02241-6457
US

V. Phone/Fax

Practice location:
  • Phone: 908-522-5545
  • Fax: 908-522-6147
Mailing address:
  • Phone: 844-362-1735
  • Fax: 973-290-7495

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number26NJ00407500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: