Healthcare Provider Details

I. General information

NPI: 1548266745
Provider Name (Legal Business Name): JAMES M RECORD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/22/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1130 MCBRIDE AVENUE
WEST PATERSON NJ
07424
US

IV. Provider business mailing address

1130 MCBRIDE AVENUE
WEST PATERSON NJ
07424
US

V. Phone/Fax

Practice location:
  • Phone: 973-256-5557
  • Fax: 973-256-5036
Mailing address:
  • Phone: 973-256-5557
  • Fax: 973-256-5036

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMA70989
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: