Basic Information
| Provider Information | |||||||||
| NPI: | 1558985150 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GLOOTZ | ||||||||
| FirstName: | FARYAL | ||||||||
| MiddleName: | MAJID | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2 MAPLE AVE | ||||||||
| Address2: | |||||||||
| City: | WALDWICK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 074631602 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7325341326 | ||||||||
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| Practice Location | |||||||||
| Address1: | 140 OLD ORANGEBURG RD | ||||||||
| Address2: | |||||||||
| City: | ORANGEBURG | ||||||||
| State: | NY | ||||||||
| PostalCode: | 109621157 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8453591000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/31/2020 | ||||||||
| LastUpdateDate: | 05/31/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/31/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 1037159 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.