Provider Demographics
NPI:1285966929
Name:GANZ, REBECCA J (RN, MA, CPNP)
Entity type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:J
Last Name:GANZ
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Gender:F
Credentials:RN, MA, CPNP
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Mailing Address - Street 1:690 KINDERKAMACK RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:ORADELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07649-1524
Mailing Address - Country:US
Mailing Address - Phone:201-634-1600
Mailing Address - Fax:201-634-1606
Practice Address - Street 1:690 KINDERKAMACK RD
Practice Address - Street 2:SUITE 102
Practice Address - City:ORADELL
Practice Address - State:NJ
Practice Address - Zip Code:07649-1524
Practice Address - Country:US
Practice Address - Phone:201-634-1600
Practice Address - Fax:201-634-1606
Is Sole Proprietor?:No
Enumeration Date:2010-02-05
Last Update Date:2017-02-24
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Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00418000364SP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY93N581Medicare PIN