Provider Demographics
NPI:1265775134
Name:GANZMAN, ADAM CRAIG (FNP-BC)
Entity type:Individual
Prefix:MR
First Name:ADAM
Middle Name:CRAIG
Last Name:GANZMAN
Suffix:
Gender:M
Credentials:FNP-BC
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 416457
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-6457
Mailing Address - Country:US
Mailing Address - Phone:844-362-1735
Mailing Address - Fax:973-290-7495
Practice Address - Street 1:99 BEAUVOIR AVE
Practice Address - Street 2:OUTPATIENT NEUROLOGY
Practice Address - City:SUMMIT
Practice Address - State:NJ
Practice Address - Zip Code:07901-3577
Practice Address - Country:US
Practice Address - Phone:908-522-5545
Practice Address - Fax:908-522-6147
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-29
Last Update Date:2020-04-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00407500363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner