Healthcare Provider Details

I. General information

NPI: 1477744555
Provider Name (Legal Business Name): PODIATRY ASSOCIATES OF ENGLEWOOD NJ PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2007
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

363 GRAND AVE
ENGLEWOOD NJ
07631-4104
US

IV. Provider business mailing address

363 GRAND AVE
ENGLEWOOD NJ
07631-4104
US

V. Phone/Fax

Practice location:
  • Phone: 201-568-6977
  • Fax: 201-568-7567
Mailing address:
  • Phone: 201-918-4000
  • Fax: 201-568-7567

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberMD1961
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberMD1961
License Number StateNJ

VIII. Authorized Official

Name: JILL HAGEN
Title or Position: PRESIDENT
Credential: DPM
Phone: 201-918-4000