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General NPI Number Information
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NPI Number | 1477624088
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Entity Type | Organization
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Legal Business Name | NORTH HALEDON MEDICAL, PC
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Dates
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Enumeration Date | 11/13/2006
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Last Update Date | 04/04/2013
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Provider Practice Location Address
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Address Line | 510 HAMBURG TPKE WAYNE COMMONS, SUITE 101
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City | WAYNE
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State | NJ
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Zip | 07470-2025
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Country | US
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Telephone | 973-942-6005
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Fax | 973-942-6009
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Provider Business Mailing Address
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Address Line | 510 HAMBURG TPKE WAYNE COMMONS, SUITE 101
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City | WAYNE
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State | NJ
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Zip | 07470-2025
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Country | US
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Telephone | 973-942-6005
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Fax | 973-942-6009
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Authorized Official
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Title or Position | DELEGATED OFFICIAL
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Name | ANTHONY BARRAVECCHIO
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Credential |
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Telephone | 973-942-6005
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 25MB06978600
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License Number State | NJ
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