Healthcare Provider Details

I. General information

NPI: 1376702407
Provider Name (Legal Business Name): NATAKI CELESTE DOUGLAS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2008
Last Update Date: 01/26/2022
Certification Date: 01/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 BERGEN ST # C
NEWARK NJ
07103-2425
US

IV. Provider business mailing address

30 BERGEN ST RM 1205
NEWARK NJ
07107-3000
US

V. Phone/Fax

Practice location:
  • Phone: 973-972-2700
  • Fax: 973-972-2739
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number229491
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: