MEDICARE: JONATHAN M ARCHER MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207X00000X	Orthopaedic Surgery Physician	25MA06794900	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1205879525
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JONATHAN M ARCHER MD

Provider Business Mailing Address
First Line	:	3 UNIVERSITY PLZ STE 205
Second Line	:
City	:	HACKENSACK
State	:	NJ
Zip	:	07601-6208
Country	:	US
Telephone Number	:	201-833-3000
Fax Number	:

Provider Business Practice Location Address
First Line	:	730 PALISADE AVE
Second Line	:	FIRST FLOOR
City	:	TEANECK
State	:	NJ
Zip	:	07666-3144
Country	:	US
Telephone Number	:	201-353-9000
Fax Number	:	201-530-0003

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/14/2006
Last Update Date	:	03/11/2024

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