Provider Demographics
NPI:1619191038
Name:VANDYK, ELIZABETH JANETTE (DNP, RN, FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:JANETTE
Last Name:VANDYK
Suffix:
Gender:F
Credentials:DNP, RN, FNP-C
Other - Prefix:MISS
Other - First Name:ELIZABETH
Other - Middle Name:JANETTE
Other - Last Name:HOOGMOED
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA RN APRNBC NPC
Mailing Address - Street 1:91 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:MIDLAND PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07432-1454
Mailing Address - Country:US
Mailing Address - Phone:201-444-6408
Mailing Address - Fax:
Practice Address - Street 1:557 BROAD ST
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07003-2885
Practice Address - Country:US
Practice Address - Phone:973-680-8300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2016-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00072500363LA2200X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJQ39817Medicare UPIN
NJ089373Medicare ID - Type UnspecifiedGROUP 053036