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General NPI Number Information
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NPI Number | 1114712320
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Entity Type | Individual
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Provider Name | SYIEDAH JILES
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Gender | Female
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Dates
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Enumeration Date | 04/10/2025
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Last Update Date | 04/10/2025
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Provider Practice Location Address
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Address Line | 30 FRANKLIN AVE
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City | MAPLEWOOD
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State | NJ
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Zip | 07040-2919
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Country | US
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Telephone | 862-438-4161
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Fax |
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Provider Business Mailing Address
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Address Line | 2933 VAUXHALL RD SUITE 7 #1084
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City | VAUXHALL
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State | NJ
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Zip | 07088
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Country | US
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Telephone | 908-244-1338
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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 | 347C00000X
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Taxonomy Name | Private Vehicle
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License Number |
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 172A00000X
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Taxonomy Name | Driver
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License Number |
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License Number State | NJ
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