Healthcare Provider Details

I. General information

NPI: 1538408356
Provider Name (Legal Business Name): MARIE SANGOSSE MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2013
Last Update Date: 02/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

745 NORTHFIELD AVE SUITE #7
WEST ORANGE NJ
07052-1144
US

IV. Provider business mailing address

745 NORTHFIELD AVE SUITE #7
WEST ORANGE NJ
07052-1144
US

V. Phone/Fax

Practice location:
  • Phone: 973-731-0200
  • Fax: 973-325-2244
Mailing address:
  • Phone: 973-731-0200
  • Fax: 973-325-2244

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25MA04902900
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number25MA04902900
License Number StateNJ

VIII. Authorized Official

Name: MARIE SANGOSSE
Title or Position: PRESIDENT
Credential: MD
Phone: 973-731-0200