Healthcare Provider Details

I. General information

NPI: 1548951536
Provider Name (Legal Business Name): NEXT DOOR MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2023
Last Update Date: 05/19/2023
Certification Date: 05/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 S ESSEX AVE STE 202
ORANGE NJ
07050-3401
US

IV. Provider business mailing address

110 SQUIRE HILL RD
MONTCLAIR NJ
07043-2516
US

V. Phone/Fax

Practice location:
  • Phone: 973-370-4000
  • Fax:
Mailing address:
  • Phone: 973-370-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MAGDY F MAHMOUD
Title or Position: CREDENTIALING OFFICER
Credential:
Phone: 973-370-4000