Healthcare Provider Details

I. General information

NPI: 1689268898
Provider Name (Legal Business Name): DOROTHY LEIGH GEFFKEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2021
Last Update Date: 10/18/2023
Certification Date: 10/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 CHURCH STREET
NEWTON NJ
07860
US

IV. Provider business mailing address

16 MAIN ST APT D5
SPARTA NJ
07871-1958
US

V. Phone/Fax

Practice location:
  • Phone: 973-600-5487
  • Fax: 973-957-3222
Mailing address:
  • Phone: 973-600-5487
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number26NJ01460800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: