MEDICARE: YELENA ANFIBIO NP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP2300X	Primary Care Nurse Practitioner	26NJ00637500	NJ
2	363LG0600X	Gerontology Nurse Practitioner	26NJ00637500	NJ
3	363LA2200X	Adult Health Nurse Practitioner	26NJ00637500	NJ

General Provider Information

NPI Number	:	1023561149
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YELENA ANFIBIO NP-C

Provider Business Mailing Address
First Line	:	29 CEDARHURST AVE FL 1
Second Line	:
City	:	WOODLAND PARK
State	:	NJ
Zip	:	07424-3002
Country	:	US
Telephone Number	:	201-562-5769
Fax Number	:

Provider Business Practice Location Address
First Line	:	506 HAMBURG TPKE STE 202
Second Line	:
City	:	WAYNE
State	:	NJ
Zip	:	07470-2069
Country	:	US
Telephone Number	:	973-595-1809
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/25/2016
Last Update Date	:	03/27/2024

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