Healthcare Provider Details

I. General information

NPI: 1437683075
Provider Name (Legal Business Name): DA MEDICAL ARTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2017
Last Update Date: 04/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 PARK AVE
RUTHERFORD NJ
07070-2748
US

IV. Provider business mailing address

305 PARK AVE
RUTHERFORD NJ
07070-2748
US

V. Phone/Fax

Practice location:
  • Phone: 201-207-9243
  • Fax: 888-627-5578
Mailing address:
  • Phone: 201-207-9243
  • Fax: 888-627-5578

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MR. DERRICK JASON ALLOWAY
Title or Position: CEO
Credential: LCSW
Phone: 201-207-9243