Healthcare Provider Details

I. General information

NPI: 1437130622
Provider Name (Legal Business Name): LEWIS JAY MUFSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/07/2005
Last Update Date: 10/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 THOREAU DR
FREEHOLD NJ
07728-4666
US

IV. Provider business mailing address

8 THOREAU DR
FREEHOLD NJ
07728-4666
US

V. Phone/Fax

Practice location:
  • Phone: 732-780-1888
  • Fax: 732-780-0148
Mailing address:
  • Phone: 732-780-1888
  • Fax: 732-780-0148

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number25689
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number101217
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: