Healthcare Provider Details

I. General information

NPI: 1710087747
Provider Name (Legal Business Name): ANDREW M HUTTER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 02/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 PLEASANT VALLEY WAY SUITE 101
WEST ORANGE NJ
07052-2956
US

IV. Provider business mailing address

1500 PLEASANT VALLEY WAY
WEST ORANGE NJ
07052-2956
US

V. Phone/Fax

Practice location:
  • Phone: 973-669-5600
  • Fax: 973-669-0199
Mailing address:
  • Phone: 973-669-5600
  • Fax: 973-669-0199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberMA045902
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: