Healthcare Provider Details

I. General information

NPI: 1790990380
Provider Name (Legal Business Name): OTAKAR R HUBSCHMANN MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2007
Last Update Date: 12/18/2023
Certification Date: 12/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 OLD SHORT HILLS RD SUITE 409
WEST ORANGE NJ
07052-1000
US

IV. Provider business mailing address

101 OLD SHORT HILLS RD SUITE 409
WEST ORANGE NJ
07052-1000
US

V. Phone/Fax

Practice location:
  • Phone: 973-322-6732
  • Fax: 973-322-6545
Mailing address:
  • Phone: 973-322-6732
  • Fax: 973-322-6545

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number25MA0315500
License Number StateNJ

VIII. Authorized Official

Name: MAUREEN MORTELL KOZIOL
Title or Position: RN
Credential:
Phone: 973-322-6732