Individual provider Active NPI

Elizabeth Ann Fortes, APN

  • Pediatric Nurse Practitioner
  • Newark, NJ
National Provider Identifier
1467093096
Registry record updated Nov 10, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Nurse PractitionerTaxonomy code 363LP0200X
License
26NJ00963800 Issued in NJ
Practice address
166 Lyons Ave FL 1
Newark, NJ 07112-2016
Phone
(973) 926-7282
NPI assigned
Oct 4, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 10, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Nurse Practitioner 363LP0200X 26NJ00963800 NJ Primary

Addresses

Primary practice location

166 Lyons Ave FL 1
Newark, NJ 07112-2016

Mailing address

433 N Broad St
Elizabeth, NJ 07208-3300
Phone (908) 436-1002

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20191223000042 NJ Practitioner - Nurse Practitioner 1052745270 Reassigns benefits to 3 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
26NJ00963800NJMDPediatric Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Optum Medical Care of New Jersey PC CurrentSince Nov 1, 2019 Accepting new patients
Optum Medical Care of New Jersey PC CurrentSince Nov 1, 2019 Accepting new patients
Rwjbh Primary Care Services CurrentSince Nov 4, 2025 Accepting new patients
Riverside Medical Group PastSince Oct 6, 2019 Accepting new patients
A.G. Dikengil, MD, PA Past Accepting new patients
Mejia Pediatrics LLC PastSince Jul 3, 2022 Accepting new patients
Newark Beth Israel Medical Center Inc Past Accepting new patients

Locations

935 River Rd
Ste 301
Edgewater, NJ 07020
Phone (201) 471-7012

324 Palisade Ave
Fl 2
Jersey City, NJ 07307
Phone (201) 386-1400

25 Kilmer Dr
Ste 107
Morganville, NJ 07751
Phone (732) 385-5262

166 Lyons Ave
Fl 1
Newark, NJ 07112
Phone (973) 926-7282

201 Lyons Ave
Newark, NJ 07112
Phone (732) 923-7455

166 Lyons Ave
Newark, NJ 07112
Phone (973) 926-7300

714 10th St
Secaucus, NJ 07094
Phone (201) 863-3346

3403 S Delsea Dr
Vineland, NJ 08360
Phone (856) 293-6974

8 Mountain Blvd
Ste J
Warren, NJ 07059
Phone (732) 893-0200

Organizations & group practices 8

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1570147200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1762732800000",
    "number": "1467093096",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "433 N BROAD ST",
            "city": "ELIZABETH",
            "state": "NJ",
            "postal_code": "072083300",
            "telephone_number": "908-436-1002"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "166 LYONS AVE FL 1",
            "city": "NEWARK",
            "state": "NJ",
            "postal_code": "071122016",
            "telephone_number": "973-926-7282"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FORTES",
        "first_name": "ELIZABETH",
        "middle_name": "ANN",
        "credential": "APN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-10-04",
        "last_updated": "2025-11-10",
        "certification_date": "2025-11-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "NJ",
            "license": "26NJ00963800",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Newark, NJ

Sources for this page

Verify at the official NPI Registry.