Healthcare Provider Details

I. General information

NPI: 1477132843
Provider Name (Legal Business Name): MICHAEL SETH OWITZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2021
Last Update Date: 08/29/2024
Certification Date: 08/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

264 BOYDEN AVE
MAPLEWOOD NJ
07040-3070
US

IV. Provider business mailing address

264 BOYDEN AVE
MAPLEWOOD NJ
07040-3070
US

V. Phone/Fax

Practice location:
  • Phone: 973-761-5200
  • Fax:
Mailing address:
  • Phone: 973-761-5200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number25MA12367200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: