Healthcare Provider Details

I. General information

NPI: 1568138998
Provider Name (Legal Business Name): DELOVE JEREMY ARTHUR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2021
Last Update Date: 01/22/2024
Certification Date: 01/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

191 MAIN ST
HACKENSACK NJ
07601-7300
US

IV. Provider business mailing address

191 MAIN ST
HACKENSACK NJ
07601-7300
US

V. Phone/Fax

Practice location:
  • Phone: 973-807-2763
  • Fax:
Mailing address:
  • Phone: 201-416-4377
  • Fax: 201-416-4375

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number28RI04093200
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: