Healthcare Provider Details

I. General information

NPI: 1063478014
Provider Name (Legal Business Name): CHAD JASON ITZKOVICH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 08/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2740 STATE ROUTE 10 SUITE 104
MORRIS PLAINS NJ
07950
US

IV. Provider business mailing address

PO BOX 305
MORRIS PLAINS NJ
07950-0305
US

V. Phone/Fax

Practice location:
  • Phone: 973-200-8224
  • Fax: 973-695-1324
Mailing address:
  • Phone: 973-200-8224
  • Fax: 973-695-1324

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number25MA08040300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: