Healthcare Provider Details

I. General information

NPI: 1316237779
Provider Name (Legal Business Name): ABRAHAM D MORGANOFF MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2011
Last Update Date: 01/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 MOUNTAIN BLVD
WARREN NJ
07059-5650
US

IV. Provider business mailing address

5 MOUNTAIN BLVD
WARREN NJ
07059-5650
US

V. Phone/Fax

Practice location:
  • Phone: 908-769-8555
  • Fax:
Mailing address:
  • Phone: 908-769-8555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License NumberMA36548
License Number StateNJ

VIII. Authorized Official

Name: DR. ABRAHAM D MORGANOFF
Title or Position: PRESIDENT
Credential: M.D.
Phone: 908-769-8555