MEDICARE: DR. MILLARD DESMOND STRUTIN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Y00000X	Otolaryngology Physician	MAO42257	NJ

General Provider Information

NPI Number	:	1598798654
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MILLARD DESMOND STRUTIN MD

Provider Business Mailing Address
First Line	:	119 DOGWOOD WAY
Second Line	:
City	:	HACKETTSTOWN
State	:	NJ
Zip	:	07840-4849
Country	:	US
Telephone Number	:	973-997-6313
Fax Number	:	973-770-7108

Provider Business Practice Location Address
First Line	:	400 VALLEY RD
Second Line	:
City	:	MOUNT ARLINGTON
State	:	NJ
Zip	:	07856-2316
Country	:	US
Telephone Number	:	973-770-7101
Fax Number	:	973-770-7108

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/09/2006
Last Update Date	:	05/15/2024

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