=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346973112
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ELZBIETA ZYCH FNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/07/2022
-----------------------------------------------------
Last Update Date | 07/07/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1 ROBERT WOOD JOHNSON PL
-----------------------------------------------------
City | NEW BRUNSWICK
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08901-1928
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-235-8717
-----------------------------------------------------
Fax | 732-235-7379
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3 ORAN PL
-----------------------------------------------------
City | MORGANVILLE
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07751-2002
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 908-338-1978
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 26NJ01333100
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------