Healthcare Provider Details

I. General information

NPI: 1881801298
Provider Name (Legal Business Name): EWA BOGACZ OT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 03/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12-15 SADDLE RIVER MAPLE GLEN CENTER
FAIR LAWN NJ
07410
US

IV. Provider business mailing address

93 BATHURST AVE
NORTH ARLINGTON NJ
07031-6106
US

V. Phone/Fax

Practice location:
  • Phone: 201-797-9522
  • Fax:
Mailing address:
  • Phone: 201-955-2093
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code273Y00000X
TaxonomyRehabilitation Hospital Unit
License Number003925-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number46TR00570800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: