Provider Demographics
NPI:1811472111
Name:ENGLEWOOD DERMATOLOGY CENTER
Entity type:Organization
Organization Name:ENGLEWOOD DERMATOLOGY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:
Authorized Official - Last Name:TASSIELLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-569-5151
Mailing Address - Street 1:300 GRAND AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-6300
Mailing Address - Country:US
Mailing Address - Phone:201-569-5151
Mailing Address - Fax:201-569-9193
Practice Address - Street 1:300 GRAND AVE STE 201
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-6300
Practice Address - Country:US
Practice Address - Phone:201-569-5151
Practice Address - Fax:201-569-9193
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-02
Last Update Date:2018-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty