Provider Demographics
NPI:1548867690
Name:OQUENDO, ELOISA
Entity type:Individual
Prefix:
First Name:ELOISA
Middle Name:
Last Name:OQUENDO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ELOISA
Other - Middle Name:
Other - Last Name:OQUENDO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1118 BERKLEY RD
Mailing Address - Street 2:
Mailing Address - City:GIBBSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08027-1608
Mailing Address - Country:US
Mailing Address - Phone:856-366-8869
Mailing Address - Fax:
Practice Address - Street 1:1118 BERKLEY RD
Practice Address - Street 2:
Practice Address - City:GIBBSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08027-1608
Practice Address - Country:US
Practice Address - Phone:856-366-8869
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-01
Last Update Date:2020-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ0450545807251E00000X
374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ20266580476Medicaid
NJ0450545807Medicaid