MEDICARE: MRS. ELIZABETH JANETTE VANDYK DNP, RN, FNP-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	26NJ00072500	NJ
2	363LF0000X	Family Nurse Practitioner	26NJ00072500	NJ

General Provider Information

NPI Number	:	1619191038
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ELIZABETH JANETTE VANDYK DNP, RN, FNP-C

Provider Business Mailing Address
First Line	:	91 PARK AVE
Second Line	:
City	:	MIDLAND PARK
State	:	NJ
Zip	:	07432-1454
Country	:	US
Telephone Number	:	201-444-6408
Fax Number	:

Provider Business Practice Location Address
First Line	:	557 BROAD ST
Second Line	:
City	:	BLOOMFIELD
State	:	NJ
Zip	:	07003-2885
Country	:	US
Telephone Number	:	973-680-8300
Fax Number	:

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

Provider Enumeration Date	:	04/13/2007
Last Update Date	:	11/04/2016

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