Healthcare Provider Details

I. General information

NPI: 1194808717
Provider Name (Legal Business Name): JOHN J DOERR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 01/10/2025
Certification Date: 01/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

914 CLIFTON AVE
CLIFTON NJ
07013-2708
US

IV. Provider business mailing address

PO BOX 684
CLIFTON NJ
07012-0684
US

V. Phone/Fax

Practice location:
  • Phone: 973-777-5022
  • Fax: 973-594-4769
Mailing address:
  • Phone: 973-777-5022
  • Fax: 973-594-4769

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2471B0102X
TaxonomyBone Densitometry Radiologic Technologist
License NumberMA048966
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code2471C3402X
TaxonomyRadiography Radiologic Technologist
License NumberMA048966
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code2471M2300X
TaxonomyMammography Radiologic Technologist
License NumberMA048966
License Number StateNJ
# 4
Primary TaxonomyN
Taxonomy Code2471S1302X
TaxonomySonography Radiologic Technologist
License NumberMA048966
License Number StateNJ
# 5
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number25MA04896600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: