MEDICARE: MRS. REBECCA J GANZ RN, MA, CPNP

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	364SP0200X	Pediatric Clinical Nurse Specialist	26NJ00418000	NJ

General Provider Information

NPI Number	:	1285966929
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. REBECCA J GANZ RN, MA, CPNP

Provider Business Mailing Address
First Line	:	690 KINDERKAMACK RD
Second Line	:	SUITE 102
City	:	ORADELL
State	:	NJ
Zip	:	07649-1524
Country	:	US
Telephone Number	:	201-634-1600
Fax Number	:	201-634-1606

Provider Business Practice Location Address
First Line	:	690 KINDERKAMACK RD
Second Line	:	SUITE 102
City	:	ORADELL
State	:	NJ
Zip	:	07649-1524
Country	:	US
Telephone Number	:	201-634-1600
Fax Number	:	201-634-1606

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

Provider Enumeration Date	:	02/05/2010
Last Update Date	:	02/24/2017

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