Healthcare Provider Details

I. General information

NPI: 1710786587
Provider Name (Legal Business Name): JONATHAN CIFFER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2025
Last Update Date: 03/12/2025
Certification Date: 03/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

612 MAIN ST
BOONTON NJ
07005-1761
US

IV. Provider business mailing address

14 LISA DR
BUDD LAKE NJ
07828-1422
US

V. Phone/Fax

Practice location:
  • Phone: 973-529-4763
  • Fax:
Mailing address:
  • Phone: 973-529-4763
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number18KT01516500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: