Healthcare Provider Details

I. General information

NPI: 1144395500
Provider Name (Legal Business Name): JOHN S FREIHEITER MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 09/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 OLD BROOKSIDE RD SUITE 2
RANDOLPH NJ
07869
US

IV. Provider business mailing address

16 OLD BROOKSIDE RD SUITE 2
RANDOLPH NJ
07869
US

V. Phone/Fax

Practice location:
  • Phone: 973-895-8884
  • Fax: 973-895-2530
Mailing address:
  • Phone: 973-895-8884
  • Fax: 973-895-2530

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMA056783
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMA056783
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: JOHN S FREIHEITER
Title or Position: MD
Credential: MD
Phone: 973-895-8884