Provider Demographics
NPI:1720344351
Name:NURSE PRACTITIONER PROFESSIONAL SERVICES INC
Entity Type:Organization
Organization Name:NURSE PRACTITIONER PROFESSIONAL SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:A
Authorized Official - Last Name:HIBBERT-OZUZU
Authorized Official - Suffix:
Authorized Official - Credentials:ANP,BC
Authorized Official - Phone:646-239-1927
Mailing Address - Street 1:350 RAMAPO VALLEY RD
Mailing Address - Street 2:SUITE # 18 -284
Mailing Address - City:OAKLAND
Mailing Address - State:NJ
Mailing Address - Zip Code:07436-2702
Mailing Address - Country:US
Mailing Address - Phone:646-239-1927
Mailing Address - Fax:
Practice Address - Street 1:100 WEST MAGNOLIA AVENUE
Practice Address - Street 2:MAYWOOD CENTER FOR HEALTH & REHABILITATION
Practice Address - City:MAYWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07607
Practice Address - Country:US
Practice Address - Phone:201-373-8300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-09
Last Update Date:2012-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00088900363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty