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General NPI Number Information
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NPI Number | 1154618874
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Entity Type | Organization
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Legal Business Name | MAYOR GROUP, LLC
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Dates
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Enumeration Date | 07/01/2011
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Last Update Date | 07/01/2011
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Provider Practice Location Address
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Address Line | 311 S LIVINGSTON AVE
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City | LIVINGSTON
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State | NJ
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Zip | 07039-3927
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Country | US
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Telephone | 973-994-0221
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 303
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City | MOUNT FREEDOM
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State | NJ
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Zip | 07970-0303
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Country | US
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Telephone | 973-998-7993
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | GILBERT MAYOR
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Credential | M.D.
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Telephone | 973-998-7993
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 25MA06640100
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License Number State | NJ
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