Healthcare Provider Details

I. General information

NPI: 1639747447
Provider Name (Legal Business Name): RELIANT ENDOCRINOLOGY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2021
Last Update Date: 07/28/2021
Certification Date: 07/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

385 CLINTON AVE STE 3
WYCKOFF NJ
07481-1934
US

IV. Provider business mailing address

637 WYCKOFF AVE STE 389
WYCKOFF NJ
07481-1438
US

V. Phone/Fax

Practice location:
  • Phone: 914-255-1333
  • Fax: 551-587-7756
Mailing address:
  • Phone:
  • Fax: 551-587-7756

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. SUHALIA BAKERYWALA
Title or Position: DOCTOR
Credential: MD
Phone: 914-255-1333