Healthcare Provider Details

I. General information

NPI: 1275305401
Provider Name (Legal Business Name): BRETT DARMETKO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/23/2023
Last Update Date: 10/23/2023
Certification Date: 10/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

394 UNIVERSITY AVE
NEWARK NJ
07102-1221
US

IV. Provider business mailing address

394 UNIVERSITY AVE
NEWARK NJ
07102-1221
US

V. Phone/Fax

Practice location:
  • Phone: 973-733-7600
  • Fax:
Mailing address:
  • Phone: 973-733-7600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number704004
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: