| Doctor Name: | ELLEN VANDERSTAD |
| NPI Number: | 1386012979 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | APN |
| License Number: | 26NJ00588600 |
| Business Practice Address: | 137 Main Rd Suite 200 Montville, NJ - 070459231 |
| Business Phone Number: | 9734020025 |
| Business Fax Number: | 9734020508 |
| Mailing Address: | 137 Main Rd, Ste 200 MONTVILLE |
| State: | NJ |
| Postal Code: | 070459231 |
| Phone Number: | 9737030018 |
| Fax Number: | |
| NPI Enumeration Date: | 09/13/2015 |
| NPI Last Update Date: | 05/05/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 26NJ00588600 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NJ |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |