Healthcare Provider Details

I. General information

NPI: 1447440615
Provider Name (Legal Business Name): ANGELA ADAMS, MD, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2007
Last Update Date: 07/25/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 KINDERKAMACK RD SUITE 102
RIVER EDGE NJ
07661-1941
US

IV. Provider business mailing address

117 KINDERKAMACK RD SUITE 102
RIVER EDGE NJ
07661-1941
US

V. Phone/Fax

Practice location:
  • Phone: 201-968-1825
  • Fax: 201-968-0110
Mailing address:
  • Phone: 201-968-1825
  • Fax: 201-968-0110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberMA2507080400
License Number StateNJ

VIII. Authorized Official

Name: DR. ANGELA ADAMS
Title or Position: MANAGING MEMBER
Credential: M.D.
Phone: 201-968-1825