Healthcare Provider Details

I. General information

NPI: 1326240284
Provider Name (Legal Business Name): ANNETTE CHRISTINA DA SILVA D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2007
Last Update Date: 08/02/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 BERGEN AVE STE 203
KEARNY NJ
07032-3324
US

IV. Provider business mailing address

206 BERGEN AVE STE 203
KEARNY NJ
07032-3324
US

V. Phone/Fax

Practice location:
  • Phone: 201-681-1800
  • Fax: 888-485-0001
Mailing address:
  • Phone: 201-681-1800
  • Fax: 888-485-0001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberA209768-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number25MB07296400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: