Provider Demographics
NPI:1568566636
Name:FELZENBERG, THERESA (APN NP)
Entity Type:Individual
Prefix:MRS
First Name:THERESA
Middle Name:
Last Name:FELZENBERG
Suffix:
Gender:F
Credentials:APN NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 WHITE ST
Mailing Address - Street 2:
Mailing Address - City:SHREWSBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:07702-4477
Mailing Address - Country:US
Mailing Address - Phone:732-747-1555
Mailing Address - Fax:732-741-8262
Practice Address - Street 1:23 WHITE ST
Practice Address - Street 2:
Practice Address - City:SHREWSBURY
Practice Address - State:NJ
Practice Address - Zip Code:07702
Practice Address - Country:US
Practice Address - Phone:732-747-1555
Practice Address - Fax:732-741-8262
Is Sole Proprietor?:No
Enumeration Date:2006-09-11
Last Update Date:2010-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NN05381800363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
046237Medicare ID - Type Unspecified
P27512Medicare UPIN