Healthcare Provider Details

I. General information

NPI: 1144269440
Provider Name (Legal Business Name): JEFFREY WHITWORTH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2006
Last Update Date: 07/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1031 MCBRIDE AVE SUITE D203
WEST PATERSON NJ
07424-2559
US

IV. Provider business mailing address

1031 MCBRIDE AVE SUITE D203
WEST PATERSON NJ
07424-2559
US

V. Phone/Fax

Practice location:
  • Phone: 973-256-6350
  • Fax: 973-256-7388
Mailing address:
  • Phone: 973-256-6350
  • Fax: 973-256-7388

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License NumberMA063604
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: