Healthcare Provider Details

I. General information

NPI: 1487827408
Provider Name (Legal Business Name): DAVID MATTHEW BANDOLA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2008
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 HAMBURG TPKE STE 204
WAYNE NJ
07470-2049
US

IV. Provider business mailing address

601 HAMBURG TPKE SUITE 204
WAYNE NJ
07470-2048
US

V. Phone/Fax

Practice location:
  • Phone: 862-248-0668
  • Fax: 973-755-0191
Mailing address:
  • Phone: 862-248-0668
  • Fax: 862-248-0669

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number25MA08735700
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number25MA08735700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: