Healthcare Provider Details

I. General information

NPI: 1790835106
Provider Name (Legal Business Name): ARLENE THE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 04/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

348 SUMMIT AVE
HACKENSACK NJ
07601-1430
US

IV. Provider business mailing address

348 SUMMIT AVE
HACKENSACK NJ
07601-1430
US

V. Phone/Fax

Practice location:
  • Phone: 201-343-9300
  • Fax:
Mailing address:
  • Phone: 201-343-9300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number25MA08643600
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: