Provider Demographics
NPI:1407026248
Name:FEBUS, LUIS A (NP)
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:A
Last Name:FEBUS
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99 GORGE RD APT 1908
Mailing Address - Street 2:
Mailing Address - City:EDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:07020-1726
Mailing Address - Country:US
Mailing Address - Phone:201-281-0327
Mailing Address - Fax:
Practice Address - Street 1:99 GORGE RD APT 1908
Practice Address - Street 2:
Practice Address - City:EDGEWATER
Practice Address - State:NJ
Practice Address - Zip Code:07020-1726
Practice Address - Country:US
Practice Address - Phone:201-281-0327
Practice Address - Fax:201-875-1195
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-07
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00151600363LP0808X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ141480OtherMEDICARE PTAN