Healthcare Provider Details

I. General information

NPI: 1154950269
Provider Name (Legal Business Name): MEDICAL ASSOCIATES OF ENGLEWOOD, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2020
Last Update Date: 04/02/2020
Certification Date: 04/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

142 ENGLE ST
ENGLEWOOD NJ
07631-2547
US

IV. Provider business mailing address

375 ENGLE ST
ENGLEWOOD NJ
07631-1823
US

V. Phone/Fax

Practice location:
  • Phone: 201-568-0033
  • Fax:
Mailing address:
  • Phone: 201-894-3012
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: HOWARD JAY LASNER
Title or Position: REVENUE DIRECTOR
Credential:
Phone: 201-608-2136