Provider Demographics
NPI:1669836334
Name:FERRANDIZ, DESIREE
Entity Type:Individual
Prefix:
First Name:DESIREE
Middle Name:
Last Name:FERRANDIZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DESIREE
Other - Middle Name:
Other - Last Name:TORRES-MARTINEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APN
Mailing Address - Street 1:38 ELMORA AVE
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:NJ
Mailing Address - Zip Code:07202-2248
Mailing Address - Country:US
Mailing Address - Phone:908-576-8982
Mailing Address - Fax:908-576-8985
Practice Address - Street 1:11 GETTY AVENUE
Practice Address - Street 2:
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07503-2806
Practice Address - Country:US
Practice Address - Phone:973-754-4701
Practice Address - Fax:973-754-4740
Is Sole Proprietor?:No
Enumeration Date:2016-04-08
Last Update Date:2019-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00630700363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care