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General NPI Number Information
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NPI Number | 1649474594
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Entity Type | Organization
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Legal Business Name | ENGLEWOOD ALLERGY ASSOCIATES, LLC
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Dates
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Enumeration Date | 06/13/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 309 ENGLE ST SUITE 2
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City | ENGLEWOOD
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State | NJ
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Zip | 07631-1824
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Country | US
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Telephone | 201-568-1480
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Fax | 201-568-1326
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Provider Business Mailing Address
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Address Line | 309 ENGLE ST SUITE 2
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City | ENGLEWOOD
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State | NJ
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Zip | 07631-1824
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Country | US
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Telephone | 201-568-1480
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Fax | 201-568-1326
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. STUART BRUCE FROM
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Credential | M.D.
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Telephone | 201-568-1480
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207K00000X
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Taxonomy Name | Allergy & Immunology Physician
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License Number | 25MA05783700
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License Number State | NJ
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