Healthcare Provider Details

I. General information

NPI: 1801280185
Provider Name (Legal Business Name): DEVON KING
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DEVON MITCHELL

II. Dates (important events)

Enumeration Date: 03/24/2015
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 PROSPECT AVE STE 805
HACKENSACK NJ
07601-1974
US

IV. Provider business mailing address

20 PROSPECT AVE STE 805
HACKENSACK NJ
07601-1974
US

V. Phone/Fax

Practice location:
  • Phone: 551-996-1771
  • Fax:
Mailing address:
  • Phone: 551-996-1771
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number25MA10633900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: