Healthcare Provider Details

I. General information

NPI: 1285430710
Provider Name (Legal Business Name): GAN ALIZA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2025
Last Update Date: 03/19/2025
Certification Date: 03/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

509 ENGLE ST
ENGLEWOOD NJ
07631-1813
US

IV. Provider business mailing address

458 W ENGLEWOOD AVE
TEANECK NJ
07666-2834
US

V. Phone/Fax

Practice location:
  • Phone: 201-308-3042
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: TSIPY KOHEN-WEISS
Title or Position: OWNER
Credential:
Phone: 201-308-3042