Healthcare Provider Details

I. General information

NPI: 1871519215
Provider Name (Legal Business Name): TONY JUNEJA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2006
Last Update Date: 10/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1215 ROUTE 70 SUITE 1001
LAKEWOOD NJ
08701-6958
US

IV. Provider business mailing address

1215 ROUTE 70 SUITE 1001
LAKEWOOD NJ
08701-6958
US

V. Phone/Fax

Practice location:
  • Phone: 732-942-5056
  • Fax:
Mailing address:
  • Phone: 732-942-5056
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number25MA08022900
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number249727-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: