Healthcare Provider Details

I. General information

NPI: 1124817648
Provider Name (Legal Business Name): BLUE ONYX MEDICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2025
Last Update Date: 05/01/2025
Certification Date: 05/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 W MAIN ST
DENVILLE NJ
07834-1600
US

IV. Provider business mailing address

11166 FAIRFAX BLVD STE 500
FAIRFAX VA
22030-5017
US

V. Phone/Fax

Practice location:
  • Phone: 973-954-9401
  • Fax:
Mailing address:
  • Phone: 973-954-9401
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2083A0300X
TaxonomyAddiction Medicine (Preventive Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: SUNIL SAXENA
Title or Position: MD/CEO
Credential: MD
Phone: 973-954-9401