Healthcare Provider Details

I. General information

NPI: 1578614723
Provider Name (Legal Business Name): DAVID ERIC KONIGSBERG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2007
Last Update Date: 10/25/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

612 GODWIN AVE
MIDLAND PARK NJ
07432
US

IV. Provider business mailing address

612 GODWIN AVE
MIDLAND PARK NJ
07432
US

V. Phone/Fax

Practice location:
  • Phone: 201-445-9000
  • Fax: 201-445-7400
Mailing address:
  • Phone: 201-445-9000
  • Fax: 201-445-7400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XP3100X
TaxonomyPediatric Orthopaedic Surgery Physician
License Number25MA06320700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: