Provider Demographics
NPI:1023306982
Name:VAN WYK, ELEANOR M (LPN)
Entity type:Individual
Prefix:MRS
First Name:ELEANOR
Middle Name:M
Last Name:VAN WYK
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 WERIMUS RD
Mailing Address - Street 2:
Mailing Address - City:WOODCLIFF LAKE
Mailing Address - State:NJ
Mailing Address - Zip Code:07677
Mailing Address - Country:US
Mailing Address - Phone:201-214-3214
Mailing Address - Fax:
Practice Address - Street 1:106 WERIMUS RD
Practice Address - Street 2:
Practice Address - City:WOODCLIFF LAKE
Practice Address - State:NJ
Practice Address - Zip Code:07677
Practice Address - Country:US
Practice Address - Phone:201-214-3215
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-13
Last Update Date:2011-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY250156-1208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery