Healthcare Provider Details

I. General information

NPI: 1184894586
Provider Name (Legal Business Name): WEST MORRIS MEDICAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2008
Last Update Date: 03/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 EAST MAIN STREET BUILDING A; SUITE 2
CHESTER NJ
07930-0599
US

IV. Provider business mailing address

PO BOX 599
CHESTER NJ
07930-0599
US

V. Phone/Fax

Practice location:
  • Phone: 973-879-4941
  • Fax:
Mailing address:
  • Phone: 973-879-4941
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number25MA05194300
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number25MA05194300
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code207RS0010X
TaxonomySports Medicine (Internal Medicine) Physician
License Number25MA05194300
License Number StateNJ
# 4
Primary TaxonomyN
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number25MA05194300
License Number StateNJ
# 5
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number25MA05194300
License Number StateNJ
# 6
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number25MA05194300
License Number StateNJ
# 7
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25MA05194300
License Number StateNJ

VIII. Authorized Official

Name: MICHAEL G DONNELLY SR.
Title or Position: AUTHORIZED MEMBER
Credential:
Phone: 973-879-4941