Healthcare Provider Details

I. General information

NPI: 1891733929
Provider Name (Legal Business Name): NORTH HALEDON MEDICAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 04/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

535 HIGH MOUNTAIN RD SUITE 202
NORTH HALEDON NJ
07508-2665
US

IV. Provider business mailing address

535 HIGH MOUNTAIN RD SUITE 202
NORTH HALEDON NJ
07508-2665
US

V. Phone/Fax

Practice location:
  • Phone: 973-427-6975
  • Fax:
Mailing address:
  • Phone: 973-427-6975
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number25MB06978600
License Number StateNJ

VIII. Authorized Official

Name: DR. ANTHONY J BARRAVECCHIO
Title or Position: OWNER
Credential: DO
Phone: 973-427-6975