Healthcare Provider Details

I. General information

NPI: 1043421035
Provider Name (Legal Business Name): NORTHERN VALLEY ENT & FACIAL PLASTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2007
Last Update Date: 09/24/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

163 ENGLE ST BUILDING 1B
ENGLEWOOD NJ
07631-2535
US

IV. Provider business mailing address

219 OLD HOOK RD
WESTWOOD NJ
07675-3131
US

V. Phone/Fax

Practice location:
  • Phone: 201-569-6789
  • Fax: 201-569-6709
Mailing address:
  • Phone: 201-666-8787
  • Fax: 201-358-6686

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207YX0007X
TaxonomyPlastic Surgery within the Head & Neck (Otolaryngology) Physician
License Number25MA04931000
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License Number25MA07571900
License Number StateNJ

VIII. Authorized Official

Name: DR. MICHAEL PHILIP SCHERL
Title or Position: OWNER,PRESIDENT
Credential: M.D.
Phone: 201-666-8787