Healthcare Provider Details

I. General information

NPI: 1942541990
Provider Name (Legal Business Name): J DERMATOLOGY AND ALLERGY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2013
Last Update Date: 03/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

460 SYLVAN AVE SUITE 205
ENGLEWOOD CLIFFS NJ
07632-2919
US

IV. Provider business mailing address

460 SYLVAN AVE SUITE 205
ENGLEWOOD CLIFFS NJ
07632-2919
US

V. Phone/Fax

Practice location:
  • Phone: 201-567-0404
  • Fax: 201-567-5590
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberMA03956200
License Number StateNJ

VIII. Authorized Official

Name: EUN H SHEEN
Title or Position: PRESIDENT
Credential: MD
Phone: 201-567-0404