Healthcare Provider Details

I. General information

NPI: 1396621983
Provider Name (Legal Business Name): MY HOME DOCTOR OF NEW JERSEY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2025
Last Update Date: 01/16/2026
Certification Date: 01/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28 VALLEY RD
MONTCLAIR NJ
07042
US

IV. Provider business mailing address

PO BOX 112
HARRISON NJ
07029-0112
US

V. Phone/Fax

Practice location:
  • Phone: 888-696-4322
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. PATRICK D. KAVANAGH
Title or Position: OWNER
Credential: MD
Phone: 305-354-0358