Individual provider Active NPI

Elizabeth S. Petrides, A.P.N.

  • Registered Nurse
  • Neptune, NJ
National Provider Identifier
1649343567
Registry record updated Sep 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered NurseTaxonomy code 163W00000X
License
NO110654 Issued in NJ
Practice address
1945 State Route 33
Neptune, NJ 07753-4859
Phone
(732) 775-5500
NPI assigned
Nov 16, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 11, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X NO110654 NJ Primary
Acute Care Nurse Practitioner 363LA2100X NN110654 NJ

Addresses

Primary practice location

1945 State Route 33
Neptune, NJ 07753-4859

Mailing address

1551 Deer Run Dr
Manasquan, NJ 08736-2501

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
I20240328002254 NJ Order and Referring Only - Nurse Practitioner 9638516404

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
NO110654NJMDRegistered Nurse
NN110654NJMDAcute Care Nurse Practitioner

NPI Registry JSON

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

{
    "created_epoch": "1163635200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1757548800000",
    "number": "1649343567",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1551 DEER RUN DR",
            "city": "MANASQUAN",
            "state": "NJ",
            "postal_code": "087362501"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1945 STATE ROUTE 33",
            "city": "NEPTUNE",
            "state": "NJ",
            "postal_code": "077534859",
            "telephone_number": "732-775-5500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETRIDES",
        "first_name": "ELIZABETH",
        "middle_name": "S.",
        "name_prefix": "Mrs.",
        "credential": "A.P.N.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-16",
        "last_updated": "2025-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "NJ",
            "license": "NO110654",
            "primary": true
        },
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "NJ",
            "license": "NN110654",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Neptune, NJ

Sources for this page

Verify at the official NPI Registry.