Healthcare Provider Details

I. General information

NPI: 1356140628
Provider Name (Legal Business Name): ANTONIO E TERUEL AGPCNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/10/2025
Last Update Date: 12/06/2025
Certification Date: 12/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

655 AMBOY AVE STE 403
WOODBRIDGE NJ
07095-3145
US

IV. Provider business mailing address

655 AMBOY AVE STE 403
WOODBRIDGE NJ
07095-3145
US

V. Phone/Fax

Practice location:
  • Phone: 732-874-7888
  • Fax:
Mailing address:
  • Phone: 732-874-7888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number26NJ15281800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: