Healthcare Provider Details

I. General information

NPI: 1982136958
Provider Name (Legal Business Name): DRS MEDICAL ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2017
Last Update Date: 03/29/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 BERGEN ST
NEWARK NJ
07103-2496
US

IV. Provider business mailing address

117 BIRCHWOOD TER
CLIFTON NJ
07012-2333
US

V. Phone/Fax

Practice location:
  • Phone: 973-972-6000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ00540300
License Number StateNJ

VIII. Authorized Official

Name: RAY SANTOS
Title or Position: OWNER
Credential: MD
Phone: 201-706-3808