Healthcare Provider Details

I. General information

NPI: 1417710831
Provider Name (Legal Business Name): NORTH JERSEY INTEGRATED MEDICINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2024
Last Update Date: 11/19/2024
Certification Date: 11/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1136 CLIFTON AVE # 1
CLIFTON NJ
07013-3622
US

IV. Provider business mailing address

1200 GRAND ST APT 422
HOBOKEN NJ
07030-2284
US

V. Phone/Fax

Practice location:
  • Phone: 908-415-9319
  • Fax:
Mailing address:
  • Phone: 908-415-9319
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code202D00000X
TaxonomyIntegrative Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL DOBROW
Title or Position: PHYSICIAN
Credential: DO
Phone: 908-415-9319