Healthcare Provider Details

I. General information

NPI: 1376778019
Provider Name (Legal Business Name): GARRETT JOSEPH NORMAN III M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2009
Last Update Date: 07/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 WESTMONT AVE
LAVALLETTE NJ
08735-2037
US

IV. Provider business mailing address

20 WESTMONT AVE
LAVALLETTE NJ
08735-2037
US

V. Phone/Fax

Practice location:
  • Phone: 732-575-7835
  • Fax:
Mailing address:
  • Phone: 732-575-7835
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number25MA09266100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: