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General NPI Number Information
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NPI Number | 1992798813
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Entity Type | Individual
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Provider Name | JORGE L MAYORAL M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/25/2005
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Last Update Date | 06/22/2021
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Provider Practice Location Address
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Address Line | 95 MOUNT KEMBLE AVE THEBAUD BUILDING, FOURTH FLOOR
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City | MORRISTOWN
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State | NJ
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Zip | 07960-5155
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Country | US
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Telephone | 973-267-2293
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Fax | 973-267-3144
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Provider Business Mailing Address
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Address Line | 95 MOUNT KEMBLE AVE THEBAUD BUILDING, FOURTH FLOOR
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City | MORRISTOWN
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State | NJ
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Zip | 07960-5155
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Country | US
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Telephone | 973-267-2293
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Fax | 973-267-3144
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | MD431776
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | MA068155
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License Number State | NJ
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