Healthcare Provider Details

I. General information

NPI: 1639170871
Provider Name (Legal Business Name): JOHN J OPPENHEIMER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2005
Last Update Date: 05/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 SADDLE RD FIRST FLOOR
CEDAR KNOLLS NJ
07927-1902
US

IV. Provider business mailing address

PO BOX 416457
BOSTON MA
02241-6457
US

V. Phone/Fax

Practice location:
  • Phone: 908-934-0555
  • Fax: 973-540-0472
Mailing address:
  • Phone: 973-656-6280
  • Fax: 973-290-7495

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License Number25MA05056200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: