Provider Demographics
NPI:1043652001
Name:VIRTUSIO, NELSON C (LPN)
Entity Type:Individual
Prefix:MR
First Name:NELSON
Middle Name:C
Last Name:VIRTUSIO
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 CARLISLE ST
Mailing Address - Street 2:
Mailing Address - City:BERGENFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07621-1603
Mailing Address - Country:US
Mailing Address - Phone:201-888-4750
Mailing Address - Fax:
Practice Address - Street 1:11 CARLISLE ST
Practice Address - Street 2:
Practice Address - City:BERGENFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07621-1603
Practice Address - Country:US
Practice Address - Phone:201-888-4750
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-18
Last Update Date:2013-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY313959-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse