Provider Demographics
NPI:1154536399
Name:VARGAS, GERALDINE (APN)
Entity type:Individual
Prefix:
First Name:GERALDINE
Middle Name:
Last Name:VARGAS
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:444 PIERMONT RD
Mailing Address - Street 2:
Mailing Address - City:DEMAREST
Mailing Address - State:NJ
Mailing Address - Zip Code:07627-2421
Mailing Address - Country:US
Mailing Address - Phone:201-996-5181
Mailing Address - Fax:201-996-4239
Practice Address - Street 1:30 PROSPECT AVE
Practice Address - Street 2:ETD OFFICE 3 MAIN RM 3624
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-1914
Practice Address - Country:US
Practice Address - Phone:201-996-3192
Practice Address - Fax:201-968-1866
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJNR71552363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care