Healthcare Provider Details

I. General information

NPI: 1699711762
Provider Name (Legal Business Name): INFECTIOUS DISEASE SPECIALISTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2006
Last Update Date: 11/28/2023
Certification Date: 11/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

189 EAGLE ROCK AVE
ROSELAND NJ
07068-1347
US

IV. Provider business mailing address

PO BOX 54
ROSELAND NJ
07068-0054
US

V. Phone/Fax

Practice location:
  • Phone: 973-980-0195
  • Fax: 973-774-1920
Mailing address:
  • Phone: 973-980-0195
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. STEPHEN SMITH
Title or Position: OWNER
Credential: MD
Phone: 973-980-0195