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General NPI Number Information
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NPI Number | 1437178449
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Entity Type | Organization
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Legal Business Name | LIVINGSTON SUBSPECIALTY GROUP, P.A.
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Dates
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Enumeration Date | 07/19/2006
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Last Update Date | 03/24/2015
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Provider Practice Location Address
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Address Line | 349 E NORTHFIELD RD SUITE 200
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City | LIVINGSTON
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State | NJ
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Zip | 07039-4802
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Country | US
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Telephone | 973-597-0900
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Fax | 973-597-0910
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Provider Business Mailing Address
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Address Line | 349 E NORTHFIELD RD SUITE 200
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City | LIVINGSTON
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State | NJ
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Zip | 07039-4802
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Country | US
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Telephone | 973-597-0900
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Fax | 973-597-0910
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Authorized Official
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Title or Position | CONTROLLER
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Name | MICHAEL BOTTI
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Credential |
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Telephone | 973-597-1690
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number | MA045093
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number | MA045092
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License Number State | NJ
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