Provider Demographics
NPI:1679569073
Name:SULAVIK, ELIZABETH JEANNE (NP)
Entity Type:Individual
Prefix:MISS
First Name:ELIZABETH
Middle Name:JEANNE
Last Name:SULAVIK
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MRS
Other - First Name:ELIZABETH
Other - Middle Name:JEANNE
Other - Last Name:GALLAGHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:126 NEW PROVIDENCE RD
Mailing Address - Street 2:
Mailing Address - City:MOUNTAINSIDE
Mailing Address - State:NJ
Mailing Address - Zip Code:07092-2522
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:RAF LAKENHEATH
Practice Address - Street 2:48 MDOS
Practice Address - City:BRANDON
Practice Address - State:SUFFOLK
Practice Address - Zip Code:IP279PN
Practice Address - Country:GB
Practice Address - Phone:908-293-3086
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-22
Last Update Date:2017-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00725000363LW0102X
NYF420721-1363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health