Healthcare Provider Details

I. General information

NPI: 1770638009
Provider Name (Legal Business Name): UNIVERSITY REPRODUCTIVE ASSOCIATES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

214 TERRACE AVE
HASBROUCK HEIGHTS NJ
07604-1815
US

IV. Provider business mailing address

214 TERRACE AVE
HASBROUCK HEIGHTS NJ
07604-1815
US

V. Phone/Fax

Practice location:
  • Phone: 201-288-6330
  • Fax: 201-288-6331
Mailing address:
  • Phone: 201-288-6330
  • Fax: 201-288-6331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number
License Number State

VIII. Authorized Official

Name: MARY FENNAR
Title or Position: OFFICE MANAGER
Credential:
Phone: 201-288-6330