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General NPI Number Information
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NPI Number | 1134701832
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Entity Type | Organization
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Legal Business Name | SWIFTTEST LLC
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Dates
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Enumeration Date | 04/22/2021
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Last Update Date | 04/22/2021
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Provider Practice Location Address
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Address Line | 78 FRANKLIN ST
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City | ENGLEWOOD
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State | NJ
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Zip | 07631-3616
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Country | US
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Telephone | 917-776-8725
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Fax |
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Provider Business Mailing Address
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Address Line | 78 FRANKLIN ST
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City | ENGLEWOOD
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State | NJ
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Zip | 07631-3616
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Country | US
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Telephone | 917-776-8725
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN ASSISTANT
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Name | MRS. ALIZA BLACK
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Credential | PA
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Telephone | 917-776-8725
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number |
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License Number State |
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