Healthcare Provider Details

I. General information

NPI: 1144959743
Provider Name (Legal Business Name): PHILLIP JOHNATHAN SGOBBA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2022
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 VALLEY HEALTH PLZ
PARAMUS NJ
07652-3619
US

IV. Provider business mailing address

500 W MAIN ST STE 16
WYCKOFF NJ
07481-1406
US

V. Phone/Fax

Practice location:
  • Phone: 201-847-9320
  • Fax:
Mailing address:
  • Phone: 201-847-9320
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number25MA13170600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: