Organization
PODIATRY ASSOCIATES OF ENGLEWOOD NJ PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JILL HAGEN DPM (PRESIDENT)
(201) 568-6977
Entity
Organization
Contact information
Practice address
363 GRAND AVE, ENGLEWOOD, NJ 07631-4104
(201) 568-6977
(201) 568-7567
Mailing address
363 GRAND AVE, ENGLEWOOD, NJ 07631-4104
(201) 568-6977
(201) 568-7567
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
MD1961
NJ
213ES0103X
Foot & Ankle Surgery Podiatrist
MD1961
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0063356
GHI ID#
NJ
01
—
0110120
AETNA ID#
NJ
01
—
0452298000
AMERIHEALTH
NJ
01
—
2139688
CIGNA ID#
NJ
05
—
6198104
—
NJ
01
—
J32278
HEALTHNET ID#
NJ
01
—
P1023259
OXFORD ID#
NJ
Enumeration date
08/05/2007
Last updated
07/31/2009
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