Healthcare Provider Details

I. General information

NPI: 1659977015
Provider Name (Legal Business Name): DOCTORS PLACE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2020
Last Update Date: 04/07/2024
Certification Date: 04/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 SUMMIT AVE STE 200
HACKENSACK NJ
07601-8504
US

IV. Provider business mailing address

226 STATE STREET #1018
HACKENSACK NJ
07601-6451
US

V. Phone/Fax

Practice location:
  • Phone: 201-734-5853
  • Fax:
Mailing address:
  • Phone: 201-540-8647
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VII. Legacy identifiers

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

VIII. Authorized Official

Name: CHANTAL GABRIEL
Title or Position: MEDICAL DIRECTOR
Credential:
Phone: 201-734-5853