Healthcare Provider Details

I. General information

NPI: 1669073318
Provider Name (Legal Business Name): WEST NEW YORK HEALING CENTER CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2020
Last Update Date: 05/13/2025
Certification Date: 05/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5300 BERGENLINE AVE STE 304
WEST NEW YORK NJ
07093-5616
US

IV. Provider business mailing address

5300 BERGENLINE AVE STE 304
WEST NEW YORK NJ
07093-5616
US

V. Phone/Fax

Practice location:
  • Phone: 201-442-0581
  • Fax:
Mailing address:
  • Phone: 201-442-0581
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RICARDO DE LOS SANTOS
Title or Position: CITO
Credential:
Phone: 201-233-9614