Healthcare Provider Details

I. General information

NPI: 1851643621
Provider Name (Legal Business Name): DAISY PUJALS L.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2012
Last Update Date: 10/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2201 BERGENLINE AVE STE 2
UNION CITY NJ
07087-3591
US

IV. Provider business mailing address

2201 BERGENLINE AVE STE 2
UNION CITY NJ
07087-3591
US

V. Phone/Fax

Practice location:
  • Phone: 201-558-3700
  • Fax:
Mailing address:
  • Phone: 201-558-3700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number44SL 04911000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: