Healthcare Provider Details

I. General information

NPI: 1912293283
Provider Name (Legal Business Name): JOHN WILLIAM NEAL VI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2011
Last Update Date: 04/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 S ORANGE AVE
NEWARK NJ
07103-2785
US

IV. Provider business mailing address

140 BERGEN ST ACC D1610
NEWARK NJ
07103-2425
US

V. Phone/Fax

Practice location:
  • Phone: 973-972-4520
  • Fax: 973-972-3897
Mailing address:
  • Phone: 973-972-4520
  • Fax: 973-972-3897

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberLL33888
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number25MA09908500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: