Healthcare Provider Details

I. General information

NPI: 1902804438
Provider Name (Legal Business Name): MICHAEL UMANOFF MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2005
Last Update Date: 08/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

703 MAIN ST
PATERSON NJ
07503-2621
US

IV. Provider business mailing address

PO BOX 1593
SECAUCUS NJ
07096-1593
US

V. Phone/Fax

Practice location:
  • Phone: 973-754-2323
  • Fax: 973-977-9455
Mailing address:
  • Phone: 201-635-1003
  • Fax: 201-635-1332

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMA45426
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number25MA04542600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: