Healthcare Provider Details

I. General information

NPI: 1063808103
Provider Name (Legal Business Name): JUSTIN NEALIS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/15/2015
Last Update Date: 11/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 WESCOTT DR
FLEMINGTON NJ
08822-4603
US

IV. Provider business mailing address

250 ROUTE 28 STE 100
BRIDGEWATER NJ
08807-1979
US

V. Phone/Fax

Practice location:
  • Phone: 908-788-6100
  • Fax:
Mailing address:
  • Phone: 908-237-4135
  • Fax: 908-237-4136

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number25MA10020800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: