Healthcare Provider Details

I. General information

NPI: 1184618886
Provider Name (Legal Business Name): DUANE FREDERICKS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2005
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

228 S ORANGE AVE
SOUTH ORANGE NJ
07079-2202
US

IV. Provider business mailing address

228 S ORANGE AVE
SOUTH ORANGE NJ
07079-2202
US

V. Phone/Fax

Practice location:
  • Phone: 973-821-5058
  • Fax: 973-821-5059
Mailing address:
  • Phone: 973-821-5058
  • Fax: 973-821-5059

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QB0002X
TaxonomyObesity Medicine (Family Medicine) Physician
License Number25MA08928300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: