Healthcare Provider Details

I. General information

NPI: 1497627467
Provider Name (Legal Business Name): TELOS HEALTH SYSTEMS NJ LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2025
Last Update Date: 02/09/2026
Certification Date: 02/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

980 SYLVAN AVE
ENGLEWOOD CLIFFS NJ
07632-3315
US

IV. Provider business mailing address

980 SYLVAN AVE
ENGLEWOOD CLIFFS NJ
07632-3315
US

V. Phone/Fax

Practice location:
  • Phone: 201-217-6777
  • Fax:
Mailing address:
  • Phone: 201-217-6777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL ALBERT RENZI
Title or Position: MEMBER
Credential: DO
Phone: 201-217-6777