Healthcare Provider Details

I. General information

NPI: 1962025759
Provider Name (Legal Business Name): ORSO-MEDICAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2020
Last Update Date: 02/20/2024
Certification Date: 02/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

59 AVON DR
ESSEX FELLS NJ
07021-1717
US

IV. Provider business mailing address

59 AVON DR
ESSEX FELLS NJ
07021-1717
US

V. Phone/Fax

Practice location:
  • Phone: 201-978-3255
  • Fax:
Mailing address:
  • Phone: 201-978-3255
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: DENISE JOHNSTONE
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 973-476-2112