Provider Demographics
NPI:1780778787
Name:CITY OF ENGLEWOOD
Entity type:Organization
Organization Name:CITY OF ENGLEWOOD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:NELSON
Authorized Official - Middle Name:XAVIER
Authorized Official - Last Name:CRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:MS,MBA
Authorized Official - Phone:201-568-3450
Mailing Address - Street 1:73 S VAN BRUNT ST
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-3426
Mailing Address - Country:US
Mailing Address - Phone:201-568-3450
Mailing Address - Fax:201-568-5738
Practice Address - Street 1:73 S VAN BRUNT ST
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-3426
Practice Address - Country:US
Practice Address - Phone:201-568-3450
Practice Address - Fax:201-568-5738
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2007-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ261QP0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local