Healthcare Provider Details

I. General information

NPI: 1316931744
Provider Name (Legal Business Name): BERNARD NEWMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2005
Last Update Date: 06/03/2020
Certification Date: 06/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

680 KINDERKAMACK RD STE 300
ORADELL NJ
07649-1600
US

IV. Provider business mailing address

680 KINDERKAMACK RD STE 300
ORADELL NJ
07649-1600
US

V. Phone/Fax

Practice location:
  • Phone: 201-342-2550
  • Fax: 201-342-7171
Mailing address:
  • Phone: 201-342-2550
  • Fax: 201-342-7171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number25MA05448200
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number25MA05448200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: