Healthcare Provider Details

I. General information

NPI: 1780254995
Provider Name (Legal Business Name): CHRISTOPHER JOSEPH DODGEN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2021
Last Update Date: 04/29/2025
Certification Date: 04/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

94 OLD SHORT HILLS RD STE 1
LIVINGSTON NJ
07039-5668
US

IV. Provider business mailing address

21 VILLAGE RD
FLORHAM PARK NJ
07932-2411
US

V. Phone/Fax

Practice location:
  • Phone: 973-322-2915
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number25MP00628800
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number25MP00628800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: