Healthcare Provider Details

I. General information

NPI: 1437178449
Provider Name (Legal Business Name): LIVINGSTON SUBSPECIALTY GROUP, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 03/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

349 E NORTHFIELD RD SUITE 200
LIVINGSTON NJ
07039-4802
US

IV. Provider business mailing address

349 E NORTHFIELD RD SUITE 200
LIVINGSTON NJ
07039-4802
US

V. Phone/Fax

Practice location:
  • Phone: 973-597-0900
  • Fax: 973-597-0910
Mailing address:
  • Phone: 973-597-0900
  • Fax: 973-597-0910

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberMA045092
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberMA045093
License Number StateNJ

VIII. Authorized Official

Name: MICHAEL BOTTI
Title or Position: CONTROLLER
Credential:
Phone: 973-597-1690