Healthcare Provider Details

I. General information

NPI: 1215359732
Provider Name (Legal Business Name): ENGLEWOOD WOMEN'S HEALTH PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2014
Last Update Date: 01/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 ROCKWOOD PL SUITE 305
ENGLEWOOD NJ
07631-4957
US

IV. Provider business mailing address

25 ROCKWOOD PL SUITE 305
ENGLEWOOD NJ
07631-4957
US

V. Phone/Fax

Practice location:
  • Phone: 201-894-0003
  • Fax: 201-894-0006
Mailing address:
  • Phone: 201-894-0003
  • Fax: 201-894-0006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number
License Number State

VIII. Authorized Official

Name: GRACE SIBILIA
Title or Position: OFFICE MANAGER
Credential:
Phone: 201-894-0003