Healthcare Provider Details

I. General information

NPI: 1568648806
Provider Name (Legal Business Name): TOWNSHIP OF WEST ORANGE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2008
Last Update Date: 02/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 GASTON STREET WEST ORANGE HEALTH CENTER
WEST ORANGE NJ
07052
US

IV. Provider business mailing address

66 MAIN ST
WEST ORANGE NJ
07052-5404
US

V. Phone/Fax

Practice location:
  • Phone: 973-325-4136
  • Fax: 973-324-0206
Mailing address:
  • Phone: 973-325-4124
  • Fax: 973-325-4005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State

VIII. Authorized Official

Name: MR. JOSEPH FONZINO
Title or Position: HEALTH OFFICER TOWNSHIP OF W O
Credential: HO
Phone: 973-325-4124