Healthcare Provider Details

I. General information

NPI: 1356339410
Provider Name (Legal Business Name): DAVID A FOST MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2005
Last Update Date: 05/12/2023
Certification Date: 05/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

197 BLOOMFIELD AVE
VERONA NJ
07044-2702
US

IV. Provider business mailing address

197 BLOOMFIELD AVE
VERONA NJ
07044-2702
US

V. Phone/Fax

Practice location:
  • Phone: 973-857-0330
  • Fax: 973-857-0980
Mailing address:
  • Phone: 973-857-0330
  • Fax: 973-857-0980

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number25MA06376600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: