Healthcare Provider Details

I. General information

NPI: 1972520633
Provider Name (Legal Business Name): THE CENTER FOR MEDICAL HEALING ON MADISON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 08/02/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 BERGEN AVE SUITE 203
KEARNY NJ
07032-3324
US

IV. Provider business mailing address

PO BOX 726
NEW YORK NY
10156-0726
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number209768-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberMB 72964
License Number StateNJ

VIII. Authorized Official

Name: DR. ANNETTE DA SILVA
Title or Position: HEAD PHYSICIAN
Credential: D.O.
Phone: 888-485-0001