Healthcare Provider Details

I. General information

NPI: 1578598090
Provider Name (Legal Business Name): NJ IDTF, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 03/30/2025
Certification Date: 03/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 SNOWHILL ST
SPOTSWOOD NJ
08884-1358
US

IV. Provider business mailing address

14 SNOWHILL ST
SPOTSWOOD NJ
08884-1358
US

V. Phone/Fax

Practice location:
  • Phone: 732-690-5846
  • Fax: 732-518-5220
Mailing address:
  • Phone: 732-690-2875
  • Fax: 732-518-5220

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number25MA05323800
License Number StateNJ

VIII. Authorized Official

Name: DR. WALTER HUSAR
Title or Position: PRESIDENT
Credential: M.D.
Phone: 732-690-2875