Healthcare Provider Details

I. General information

NPI: 1548377286
Provider Name (Legal Business Name): BARBARA LEE SCANLON CNM / MSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

58 SUMMIT AVE
HACKENSACK NJ
07601-1263
US

IV. Provider business mailing address

89 WILLOWBROOK CT
PARAMUS NJ
07652-1832
US

V. Phone/Fax

Practice location:
  • Phone: 201-489-2255
  • Fax: 201-489-4799
Mailing address:
  • Phone: 201-489-2255
  • Fax: 201-489-4799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberME00018101
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: