MEDICARE: MR. ELIZALDE LEGARDA VILLARUZ APN

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	363LA2100X	Acute Care Nurse Practitioner	2NJ00970500	NJ

General Provider Information

NPI Number	:	1124651203
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ELIZALDE LEGARDA VILLARUZ APN

Provider Business Mailing Address
First Line	:	1 SLATE HILL RD
Second Line	:
City	:	NEWTON
State	:	NJ
Zip	:	07860-1113
Country	:	US
Telephone Number	:	973-383-8865
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 SLATE HILL RD
Second Line	:
City	:	NEWTON
State	:	NJ
Zip	:	07860-1113
Country	:	US
Telephone Number	:	973-383-8865
Fax Number	:

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

Provider Enumeration Date	:	02/18/2020
Last Update Date	:	02/18/2020

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