Provider Demographics
NPI:1558985150
Name:GLOOTZ, FARYAL (NP)
Entity type:Individual
Prefix:MRS
First Name:FARYAL
Middle Name:
Last Name:GLOOTZ
Suffix:
Gender:
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:WALDWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:07463-1602
Mailing Address - Country:US
Mailing Address - Phone:732-534-1326
Mailing Address - Fax:
Practice Address - Street 1:992 CLIFTON AVE
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07013-3502
Practice Address - Country:US
Practice Address - Phone:862-249-1266
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-31
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY345927363L00000X
NY406887363LP0808X
NJ26NJ01035900363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health