Healthcare Provider Details

I. General information

NPI: 1033117171
Provider Name (Legal Business Name): JOSEPH DUFFY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2005
Last Update Date: 05/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 HAMBURG TPKE SUITE 14
WAYNE NJ
07470-2110
US

IV. Provider business mailing address

220 HAMBURG TPKE SUITE 14
WAYNE NJ
07470-2110
US

V. Phone/Fax

Practice location:
  • Phone: 973-942-0200
  • Fax: 973-942-0202
Mailing address:
  • Phone: 973-942-0200
  • Fax: 973-942-0202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number25MA05656700
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMA056567
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: