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General NPI Number Information
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NPI Number | 1477744555
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Entity Type | Organization
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Legal Business Name | PODIATRY ASSOCIATES OF ENGLEWOOD NJ PC
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Dates
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Enumeration Date | 08/05/2007
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Last Update Date | 07/31/2009
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Provider Practice Location Address
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Address Line | 363 GRAND AVE
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City | ENGLEWOOD
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State | NJ
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Zip | 07631-4104
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Country | US
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Telephone | 201-568-6977
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Fax | 201-568-7567
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Provider Business Mailing Address
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Address Line | 363 GRAND AVE
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City | ENGLEWOOD
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State | NJ
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Zip | 07631-4104
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Country | US
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Telephone | 201-568-6977
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Fax | 201-568-7567
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Authorized Official
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Title or Position | PRESIDENT
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Name | JILL HAGEN
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Credential | DPM
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Telephone | 201-568-6977
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | MD1961
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | MD1961
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License Number State | NJ
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