Healthcare Provider Details

I. General information

NPI: 1134261530
Provider Name (Legal Business Name): SHERWOOD BAXTMDPA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

351 EVELYN ST 2ND FLOOR
PARAMUS NJ
07652-2901
US

IV. Provider business mailing address

351 EVELYN ST 2ND FLOOR
PARAMUS NJ
07652-2901
US

V. Phone/Fax

Practice location:
  • Phone: 201-265-1300
  • Fax: 201-265-3737
Mailing address:
  • Phone: 201-265-1300
  • Fax: 201-265-3737

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MELINDA L JOSE
Title or Position: OFFICE MANAGER
Credential:
Phone: 201-265-1300