Healthcare Provider Details

I. General information

NPI: 1508872631
Provider Name (Legal Business Name): ADAM SIVITZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 09/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 LYONS AVE
NEWARK NJ
07112-2027
US

IV. Provider business mailing address

201 LYONS AVE
NEWARK NJ
07112-2027
US

V. Phone/Fax

Practice location:
  • Phone: 973-926-2484
  • Fax: 973-282-0562
Mailing address:
  • Phone: 973-926-2484
  • Fax: 973-282-0562

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PP0204X
TaxonomyPediatric Emergency Medicine (Emergency Medicine) Physician
License Number25MA08446300
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD11817
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: