Provider Demographics
NPI:1588242374
Name:ANDAYA, ELIEZL R (APN)
Entity type:Individual
Prefix:
First Name:ELIEZL
Middle Name:R
Last Name:ANDAYA
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 1:30 CIRCLE DR
Mailing Address - Street 2:
Mailing Address - City:ROCKAWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:07866-1635
Mailing Address - Country:US
Mailing Address - Phone:732-343-1341
Mailing Address - Fax:
Practice Address - Street 1:30 CIRCLE DR
Practice Address - Street 2:
Practice Address - City:ROCKAWAY
Practice Address - State:NJ
Practice Address - Zip Code:07866-1635
Practice Address - Country:US
Practice Address - Phone:732-343-1341
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-01
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ01128700363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care