Healthcare Provider Details

I. General information

NPI: 1003595901
Provider Name (Legal Business Name): JAMES MANUEL FEDERICA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2023
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 E NORTHFIELD RD FL 1
LIVINGSTON NJ
07039-4532
US

IV. Provider business mailing address

45 MANCHESTER WAY
PINE BROOK NJ
07058-9553
US

V. Phone/Fax

Practice location:
  • Phone: 973-436-1330
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number25MP00797100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: