Healthcare Provider Details

I. General information

NPI: 1780743336
Provider Name (Legal Business Name): SUSSEX COUNTY TOTAL HEALTH, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2006
Last Update Date: 08/03/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 MILL ST
NEWTON NJ
07860-1411
US

IV. Provider business mailing address

80 MILL ST
NEWTON NJ
07860-1411
US

V. Phone/Fax

Practice location:
  • Phone: 973-579-1660
  • Fax: 973-579-9185
Mailing address:
  • Phone: 973-579-1660
  • Fax: 973-579-9185

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number38MC02219
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA00240000
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA01033500
License Number StateNJ

VIII. Authorized Official

Name: JOHN T FORD
Title or Position: OWNER
Credential: D.C.
Phone: 973-579-1660