Healthcare Provider Details

I. General information

NPI: 1205895224
Provider Name (Legal Business Name): DOUGLAS ROY FENKART M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2006
Last Update Date: 07/28/2022
Certification Date: 07/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

TENAFLY PEDIATRICS, P.A. 32 FRANKLIN STREET
TENAFLY NJ
07670
US

IV. Provider business mailing address

TENAFLY PEDIATRICS, P.A. 32 FRANKLIN STREET
TENAFLY NJ
07670
US

V. Phone/Fax

Practice location:
  • Phone: 201-569-2400
  • Fax:
Mailing address:
  • Phone: 201-652-0300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMA059714
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: