Healthcare Provider Details

I. General information

NPI: 1134523780
Provider Name (Legal Business Name): GEORGE HARB
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2014
Last Update Date: 05/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

148 PARK ST
MONTCLAIR NJ
07042-2909
US

IV. Provider business mailing address

70 S ORANGE AVE
LIVINGSTON NJ
07039-4910
US

V. Phone/Fax

Practice location:
  • Phone: 973-509-6567
  • Fax:
Mailing address:
  • Phone: 973-994-4738
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number25MA06101100
License Number StateNJ

VIII. Authorized Official

Name: DR. GEORGE ELIAS HARB
Title or Position: PHYSICIAN
Credential: MD
Phone: 973-509-6567