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General NPI Number Information
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NPI Number | 1770632879
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Entity Type | Organization
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Legal Business Name | R M C N J PA
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Dates
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Enumeration Date | 01/09/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 667 EAGLE ROCK AVE
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City | WEST ORANGE
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State | NJ
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Zip | 07052-2177
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Country | US
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Telephone | 973-731-8112
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Fax |
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Provider Business Mailing Address
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Address Line | 667 EAGLE ROCK AVE
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City | WEST ORANGE
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State | NJ
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Zip | 07052-2177
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Country | US
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Telephone | 973-731-8112
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Fax |
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Authorized Official
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Title or Position | OWNER-PHYSICIAN
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Name | DR. DOV JOHANAN RAND
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Credential |
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Telephone | 973-731-8112
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225500000X
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Taxonomy Name | Respiratory/Developmental/Rehabilitative Specialist/Technologist
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License Number | 25MA05832500
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License Number State | NJ
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