Provider Demographics
NPI:1609067057
Name:BIZUB, FAY O (NP)
Entity Type:Individual
Prefix:
First Name:FAY
Middle Name:O
Last Name:BIZUB
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2102 CORLIES AVE
Mailing Address - Street 2:
Mailing Address - City:NEPTUNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07753-6141
Mailing Address - Country:US
Mailing Address - Phone:732-776-8535
Mailing Address - Fax:732-776-6601
Practice Address - Street 1:222 SCHANCK RD
Practice Address - Street 2:SUITE 104
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-3068
Practice Address - Country:US
Practice Address - Phone:732-431-1332
Practice Address - Fax:732-776-6601
Is Sole Proprietor?:No
Enumeration Date:2007-08-09
Last Update Date:2007-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00079000363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner