Provider Demographics
NPI:1336332691
Name:LOUIZIDES, GARY RUSSELL (RNFA, SA-C)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:RUSSELL
Last Name:LOUIZIDES
Suffix:
Gender:M
Credentials:RNFA, SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:554 LINWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07450-3520
Mailing Address - Country:US
Mailing Address - Phone:201-887-2030
Mailing Address - Fax:
Practice Address - Street 1:554 LINWOOD AVE
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450-3520
Practice Address - Country:US
Practice Address - Phone:201-887-2030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-21
Last Update Date:2007-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NO11195600163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant