Provider Demographics
NPI:1124651203
Name:VILLARUZ, ELIZALDE LEGARDA (APN)
Entity type:Individual
Prefix:MR
First Name:ELIZALDE
Middle Name:LEGARDA
Last Name:VILLARUZ
Suffix:
Gender:M
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 SLATE HILL RD
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07860-1113
Mailing Address - Country:US
Mailing Address - Phone:973-383-8865
Mailing Address - Fax:
Practice Address - Street 1:1 SLATE HILL RD
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:NJ
Practice Address - Zip Code:07860-1113
Practice Address - Country:US
Practice Address - Phone:973-383-8865
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-18
Last Update Date:2020-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ2NJ00970500363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care