Healthcare Provider Details

I. General information

NPI: 1063265536
Provider Name (Legal Business Name): ANGEL LUIS PIRIZ FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2024
Last Update Date: 04/08/2024
Certification Date: 04/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

322 38TH ST
UNION CITY NJ
07087-5283
US

IV. Provider business mailing address

812 LARCH ST
ROSELLE PARK NJ
07204-1207
US

V. Phone/Fax

Practice location:
  • Phone: 201-865-9492
  • Fax: 201-865-0306
Mailing address:
  • Phone: 917-494-6150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ01368900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: