Healthcare Provider Details

I. General information

NPI: 1427636075
Provider Name (Legal Business Name): JUSTIN HAM DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2021
Last Update Date: 11/05/2025
Certification Date: 11/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

176 PALISADE AVE
JERSEY CITY NJ
07306-1196
US

IV. Provider business mailing address

333 BORTHWICK AVE STE 100
PORTSMOUTH NH
03801-4198
US

V. Phone/Fax

Practice location:
  • Phone: 201-795-8200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number25MB12768700
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207RS0010X
TaxonomySports Medicine (Internal Medicine) Physician
License Number25MB1278700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: