Healthcare Provider Details

I. General information

NPI: 1053900209
Provider Name (Legal Business Name): DEBRA TAWIL APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2021
Last Update Date: 07/07/2021
Certification Date: 07/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 ENGLE ST
ENGLEWOOD NJ
07631-1808
US

IV. Provider business mailing address

1128 BROMLEY AVE
TEANECK NJ
07666-1918
US

V. Phone/Fax

Practice location:
  • Phone: 201-894-3202
  • Fax:
Mailing address:
  • Phone: 201-401-7545
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ01050900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: