Provider Demographics
NPI:1124071980
Name:ENGLEWOOD HOSPITAL AND MEDICAL CENTER
Entity type:Organization
Organization Name:ENGLEWOOD HOSPITAL AND MEDICAL CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:A
Authorized Official - Last Name:DUCHAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-894-3002
Mailing Address - Street 1:350 ENGLE ST
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-1808
Mailing Address - Country:US
Mailing Address - Phone:201-894-3314
Mailing Address - Fax:201-569-6255
Practice Address - Street 1:350 ENGLE ST
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-1808
Practice Address - Country:US
Practice Address - Phone:201-894-3314
Practice Address - Fax:201-569-6255
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ENGLEWOOD HOSPITAL AND MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-19
Last Update Date:2007-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ10202273R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4138333Medicaid
NJ31S045Medicare PIN