Healthcare Provider Details

I. General information

NPI: 1366616971
Provider Name (Legal Business Name): GLADYS SILLERO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2008
Last Update Date: 09/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7600 RIVER RD
NORTH BERGEN NJ
07047-6217
US

IV. Provider business mailing address

7600 RIVER RD
NORTH BERGEN NJ
07047-6217
US

V. Phone/Fax

Practice location:
  • Phone: 201-854-5761
  • Fax:
Mailing address:
  • Phone: 201-854-5761
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number26NO08874900
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code364SC0200X
TaxonomyCritical Care Medicine Clinical Nurse Specialist
License Number26NC08874900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: