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General NPI Number Information
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NPI Number | 1811472111
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Entity Type | Organization
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Legal Business Name | ENGLEWOOD DERMATOLOGY CENTER
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Dates
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Enumeration Date | 10/02/2018
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Last Update Date | 10/02/2018
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Provider Practice Location Address
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Address Line | 300 GRAND AVE STE 201
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City | ENGLEWOOD
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State | NJ
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Zip | 07631-6300
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Country | US
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Telephone | 201-569-5151
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Fax | 201-569-9193
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Provider Business Mailing Address
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Address Line | 300 GRAND AVE STE 201
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City | ENGLEWOOD
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State | NJ
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Zip | 07631-6300
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Country | US
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Telephone | 201-569-5151
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Fax | 201-569-9193
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Authorized Official
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Title or Position | BUSINESS MANAGER
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Name | MRS. MARGARET TASSIELLO
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Credential |
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Telephone | 201-569-5151
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number |
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License Number State |
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