Healthcare Provider Details

I. General information

NPI: 1629036306
Provider Name (Legal Business Name): HADLEY H PHILLIPS DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 02/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

619 RIVER DR
ELMWOOD PARK NJ
07407-1317
US

IV. Provider business mailing address

619 RIVER DR
ELMWOOD PARK NJ
07407-1317
US

V. Phone/Fax

Practice location:
  • Phone: 201-796-2020
  • Fax: 201-796-4833
Mailing address:
  • Phone: 201-796-2020
  • Fax: 201-796-4833

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number25MB04177700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: