Healthcare Provider Details

I. General information

NPI: 1952097156
Provider Name (Legal Business Name): EAST RIVER MEDICAL ASSOCIATES OF NEW JERSEY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2023
Last Update Date: 09/26/2025
Certification Date: 09/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 FRANKLIN TPKE STE 200
MAHWAH NJ
07430-3518
US

IV. Provider business mailing address

PO BOX 626
GREAT RIVER NY
11739-0626
US

V. Phone/Fax

Practice location:
  • Phone: 201-267-7000
  • Fax: 201-267-9799
Mailing address:
  • Phone: 631-892-2745
  • Fax: 631-201-3179

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. DOUGLAS S. WETMORE
Title or Position: PRESIDENT
Credential: MD
Phone: 201-267-7000