Healthcare Provider Details

I. General information

NPI: 1497824163
Provider Name (Legal Business Name): MICHELLE TAWIL DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 GRAND AVE 1
ENGLEWOOD NJ
07631-4967
US

IV. Provider business mailing address

500 GRAND AVE 1
ENGLEWOOD NJ
07631-4967
US

V. Phone/Fax

Practice location:
  • Phone: 201-567-2277
  • Fax: 201-567-7506
Mailing address:
  • Phone: 201-567-2277
  • Fax: 201-567-7506

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License NumberQA009855
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: