Healthcare Provider Details

I. General information

NPI: 1801057997
Provider Name (Legal Business Name): JOSE S. CAMPOS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2008
Last Update Date: 12/31/2019
Certification Date: 12/31/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 ROUTE 23 SOUTH 2ND FLOOR
POMPTON PLAINS NJ
07444-1025
US

IV. Provider business mailing address

901 ROUTE 23 SOUTH 2ND FLOOR
POMPTON PLAINS NJ
07444-1025
US

V. Phone/Fax

Practice location:
  • Phone: 862-666-9285
  • Fax: 862-666-9287
Mailing address:
  • Phone: 862-666-9285
  • Fax: 862-666-9287

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number25MA09196100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: