Healthcare Provider Details

I. General information

NPI: 1811037401
Provider Name (Legal Business Name): LIVIA GRANATA-SAKELLARIS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 GRAND AVE
ENGLEWOOD NJ
07631-3574
US

IV. Provider business mailing address

PO BOX 428
TENAFLY NJ
07670-0428
US

V. Phone/Fax

Practice location:
  • Phone: 201-233-5789
  • Fax:
Mailing address:
  • Phone: 201-233-5789
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P2900X
TaxonomyPain Medicine (Psychiatry & Neurology) Physician
License NumberMA62027
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: