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General NPI Number Information
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NPI Number | 1073883229
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Entity Type | Individual
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Provider Name | SUHALIA BAKERYWALA M.D.
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Gender | Female
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Dates
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Enumeration Date | 01/05/2012
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Last Update Date | 09/03/2021
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Provider Practice Location Address
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Address Line | 385 CLINTON AVE
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City | WYCKOFF
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State | NJ
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Zip | 07481-1934
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Country | US
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Telephone | 551-209-3555
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Fax | 551-236-2555
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Provider Business Mailing Address
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Address Line | 637 WYCKOFF AVE STE 389
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City | WYCKOFF
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State | NJ
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Zip | 07481-1438
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Country | US
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Telephone | 914-255-1333
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number | 25MA09870400
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License Number State | NJ
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