Healthcare Provider Details

I. General information

NPI: 1841215969
Provider Name (Legal Business Name): ELI S DJEBIYAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 06/25/2024
Certification Date: 06/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 GRAND AVE
ENGLEWOOD NJ
07631-6581
US

IV. Provider business mailing address

140 GRAND AVE
ENGLEWOOD NJ
07631-6581
US

V. Phone/Fax

Practice location:
  • Phone: 201-569-9010
  • Fax: 201-569-9063
Mailing address:
  • Phone: 201-569-9010
  • Fax: 201-569-9063

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25MA06812100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: