Healthcare Provider Details

I. General information

NPI: 1598798654
Provider Name (Legal Business Name): MILLARD DESMOND STRUTIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 05/15/2024
Certification Date: 05/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 VALLEY RD
MOUNT ARLINGTON NJ
07856-2316
US

IV. Provider business mailing address

119 DOGWOOD WAY
HACKETTSTOWN NJ
07840-4849
US

V. Phone/Fax

Practice location:
  • Phone: 973-770-7101
  • Fax: 973-770-7108
Mailing address:
  • Phone: 973-997-6313
  • Fax: 973-770-7108

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberMAO42257
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: