Healthcare Provider Details

I. General information

NPI: 1215985908
Provider Name (Legal Business Name): SPECIALTY CARE OF PRACTICE ASSOCIATES,PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 09/27/2022
Certification Date: 09/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MADISON AVE PHYSICAINS SHARED SERVICES BOX 68
MORRISTOWN NJ
07960-6136
US

IV. Provider business mailing address

PO BOX 23831
NEWARK NJ
07189-0001
US

V. Phone/Fax

Practice location:
  • Phone: 973-971-7185
  • Fax:
Mailing address:
  • Phone: 973-971-5595
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: CHRISTOPHER HERZOG
Title or Position: CHIEF OPERATING OFFICE
Credential:
Phone: 973-829-4320