Healthcare Provider Details

I. General information

NPI: 1972635191
Provider Name (Legal Business Name): ELIZABETH GANOPOLSKY, MD. PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2007
Last Update Date: 05/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 ENGLE ST
ENGLEWOOD NJ
07631-2905
US

IV. Provider business mailing address

40 ENGLE ST
ENGLEWOOD NJ
07631-2905
US

V. Phone/Fax

Practice location:
  • Phone: 201-567-0522
  • Fax: 201-567-5955
Mailing address:
  • Phone: 201-567-0522
  • Fax: 201-567-5955

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number25MA06944500
License Number StateNJ

VIII. Authorized Official

Name: DR. ELIZABETH GANOPOLSKY
Title or Position: M.D.
Credential: M.D.
Phone: 201-567-0522