Healthcare Provider Details

I. General information

NPI: 1699859249
Provider Name (Legal Business Name): DAUGHTERS OF MIRIAM CTR PHYSICIAN GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 HAZEL ST
CLIFTON NJ
07011-3423
US

IV. Provider business mailing address

155 HAZEL ST
CLIFTON NJ
07011-3423
US

V. Phone/Fax

Practice location:
  • Phone: 973-253-5210
  • Fax: 973-772-8243
Mailing address:
  • Phone: 973-253-5210
  • Fax: 973-772-8243

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number StateNULL

VIII. Authorized Official

Name: FRANK DASILVA
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 973-253-5210