MEDICARE: MRS. VICTORIA ELLEN EFTYCHIOU RN, APN, 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	363LA2200X	Adult Health Nurse Practitioner	26NN07903400	NJ

General Provider Information

NPI Number	:	1518937994
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. VICTORIA ELLEN EFTYCHIOU RN, APN, C

Provider Business Mailing Address
First Line	:	15 BROOK AVE
Second Line	:
City	:	MONTVALE
State	:	NJ
Zip	:	07645-2101
Country	:	US
Telephone Number	:	201-391-9841
Fax Number	:

Provider Business Practice Location Address
First Line	:	400 S ORANGE AVE
Second Line	:
City	:	SOUTH ORANGE
State	:	NJ
Zip	:	07079-2646
Country	:	US
Telephone Number	:	973-761-9175
Fax Number	:

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

Provider Enumeration Date	:	01/26/2006
Last Update Date	:	07/08/2007

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