Healthcare Provider Details

I. General information

NPI: 1306792064
Provider Name (Legal Business Name): TERESA SHARLENE BITTOL BANGWA
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/05/2026
Last Update Date: 03/05/2026
Certification Date: 03/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 SUMMIT AVE STE 106
HACKENSACK NJ
07601-1271
US

IV. Provider business mailing address

860 WILLIAMS AVE
TEANECK NJ
07666-2518
US

V. Phone/Fax

Practice location:
  • Phone: 201-336-0095
  • Fax:
Mailing address:
  • Phone: 201-286-0985
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ01428700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: