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General NPI Number Information
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NPI Number | 1891733929
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Entity Type | Organization
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Legal Business Name | NORTH HALEDON MEDICAL
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Dates
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Enumeration Date | 06/02/2006
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Last Update Date | 04/04/2013
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Provider Practice Location Address
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Address Line | 535 HIGH MOUNTAIN RD SUITE 202
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City | NORTH HALEDON
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State | NJ
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Zip | 07508-2665
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Country | US
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Telephone | 973-427-6975
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Fax |
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Provider Business Mailing Address
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Address Line | 535 HIGH MOUNTAIN RD SUITE 202
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City | NORTH HALEDON
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State | NJ
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Zip | 07508-2665
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Country | US
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Telephone | 973-427-6975
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. ANTHONY J BARRAVECCHIO
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Credential | DO
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Telephone | 973-427-6975
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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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