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General NPI Number Information
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NPI Number | 1053062539
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Entity Type | Organization
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Legal Business Name | OSTEOPATHIC FAMILY MEDICINE OF NORTHERN NJ LLC
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Dates
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Enumeration Date | 01/16/2022
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Last Update Date | 12/14/2022
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Provider Practice Location Address
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Address Line | 541 CEDAR HILL AVE
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City | WYCKOFF
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State | NJ
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Zip | 07481-2150
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Country | US
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Telephone | 551-500-5708
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Fax |
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Provider Business Mailing Address
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Address Line | 541 CEDAR HILL AVE STE 2
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City | WYCKOFF
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State | NJ
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Zip | 07481-2133
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Country | US
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Telephone | 551-815-1000
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Fax | 551-815-1001
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Authorized Official
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Title or Position | PHYSICIAN OWNER
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Name | DR. DANIEL DEFEO
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Credential | DO
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Telephone | 551-815-1000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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