Healthcare Provider Details

I. General information

NPI: 1336680214
Provider Name (Legal Business Name): ENGLEWOOD EYE CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2017
Last Update Date: 03/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

71 GRAND AVE
ENGLEWOOD NJ
07631-3531
US

IV. Provider business mailing address

71 GRAND AVE
ENGLEWOOD NJ
07631-3531
US

V. Phone/Fax

Practice location:
  • Phone: 201-408-4441
  • Fax: 201-408-4452
Mailing address:
  • Phone: 201-408-4441
  • Fax: 201-408-4452

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: DANIEL STEGMAN
Title or Position: OWNER/ MEDICAL DOCTOR
Credential: M.D.
Phone: 973-546-5700