Provider Demographics
NPI:1033595897
Name:WINDSOR ADVANCED PRACTICE NURSING PC
Entity Type:Organization
Organization Name:WINDSOR ADVANCED PRACTICE NURSING PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NUESE PRACTITIONOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:DEPERALTA
Authorized Official - Suffix:
Authorized Official - Credentials:MSN, APN-BC
Authorized Official - Phone:201-767-0100
Mailing Address - Street 1:100 MCCLELLEN ST
Mailing Address - Street 2:
Mailing Address - City:NORWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07648-1555
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:100 MCCLELLEN ST
Practice Address - Street 2:
Practice Address - City:NORWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07648-1555
Practice Address - Country:US
Practice Address - Phone:201-767-0100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-04
Last Update Date:2015-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1OtherAPPLIED FOR