=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699955153
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ROXBURY TOWNSHIP HEALTH DEPT
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/13/2007
-----------------------------------------------------
Last Update Date | 08/27/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 72 EYLAND AVE
-----------------------------------------------------
City | SUCCASUNNA
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07876-1622
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-448-2028
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 72 EYLAND AVE
-----------------------------------------------------
City | SUCCASUNNA
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07876-1622
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | HEALTH OFFICER
-----------------------------------------------------
Name | MR. FRANK A GRISI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 973-448-2029
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251K00000X
-----------------------------------------------------
Taxonomy Name | Public Health or Welfare Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------