Healthcare Provider Details

I. General information

NPI: 1770632879
Provider Name (Legal Business Name): R M C N J PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

667 EAGLE ROCK AVE
WEST ORANGE NJ
07052-2177
US

IV. Provider business mailing address

667 EAGLE ROCK AVE
WEST ORANGE NJ
07052-2177
US

V. Phone/Fax

Practice location:
  • Phone: 973-731-8112
  • Fax:
Mailing address:
  • Phone: 973-731-8112
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225500000X
TaxonomyRespiratory/Developmental/Rehabilitative Specialist/Technologist
License Number25MA05832500
License Number StateNJ

VIII. Authorized Official

Name: DR. DOV JOHANAN RAND
Title or Position: OWNER-PHYSICIAN
Credential:
Phone: 973-731-8112