Healthcare Provider Details

I. General information

NPI: 1639948805
Provider Name (Legal Business Name): EDEN RABBAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/28/2023
Last Update Date: 05/30/2024
Certification Date: 05/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 ROCKWOOD PL STE 110
ENGLEWOOD NJ
07631-4959
US

IV. Provider business mailing address

25 ROCKWOOD PL STE 110
ENGLEWOOD NJ
07631-4959
US

V. Phone/Fax

Practice location:
  • Phone: 609-464-0526
  • Fax:
Mailing address:
  • Phone: 201-894-5805
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number311022
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number26NJ15012200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: