Healthcare Provider Details

I. General information

NPI: 1306781299
Provider Name (Legal Business Name): MOUNT FREEDOM MEDICAL ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2026
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 OLD BROOKSIDE RD
RANDOLPH NJ
07869-3617
US

IV. Provider business mailing address

7 SKYLINE DR
RANDOLPH NJ
07869-2156
US

V. Phone/Fax

Practice location:
  • Phone: 609-592-2293
  • Fax: 347-719-3010
Mailing address:
  • Phone: 609-592-2293
  • Fax: 347-719-3010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JASVENDAR SINGH NANDRA
Title or Position: MD
Credential:
Phone: 609-592-2293