Healthcare Provider Details

I. General information

NPI: 1972075307
Provider Name (Legal Business Name): SHIRA ENGLARD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/24/2018
Last Update Date: 12/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1525 PROSPECT ST STE 206
LAKEWOOD NJ
08701-4662
US

IV. Provider business mailing address

16A NEGBA ST
LAKEWOOD NJ
08701-3594
US

V. Phone/Fax

Practice location:
  • Phone: 732-961-7413
  • Fax:
Mailing address:
  • Phone: 732-267-2219
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: