Healthcare Provider Details

I. General information

NPI: 1598022550
Provider Name (Legal Business Name): JAY LOVENHEIM, DO, FAAP, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2012
Last Update Date: 04/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 OLD SHORT HILLS RD SUITE 105
WEST ORANGE NJ
07052-1000
US

IV. Provider business mailing address

101 OLD SHORT HILLS RD SUITE 105
WEST ORANGE NJ
07052-1000
US

V. Phone/Fax

Practice location:
  • Phone: 973-325-1115
  • Fax: 973-325-1186
Mailing address:
  • Phone: 973-325-1115
  • Fax: 973-325-1186

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number25MB08056500
License Number StateNJ

VIII. Authorized Official

Name: DR. JAY LOVENHEIM
Title or Position: OWNER
Credential: DO
Phone: 973-325-1115