MEDICARE: FAMILY MEDICINE OF MORRIS L.L.C.

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	207Q00000X	Family Medicine Physician	MB47134	NJ

General Provider Information

NPI Number	:	1952432601
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY MEDICINE OF MORRIS L.L.C.

Provider Business Mailing Address
First Line	:	PO BOX 170
Second Line	:	124 NORTH BEVERWYCK RD
City	:	LAKE HIAWATHA
State	:	NJ
Zip	:	07034-0170
Country	:	US
Telephone Number	:	973-334-1660
Fax Number	:	973-334-6085

Provider Business Practice Location Address
First Line	:	124 N BEVERWYCK RD
Second Line	:
City	:	LAKE HIAWATHA
State	:	NJ
Zip	:	07034-2205
Country	:	US
Telephone Number	:	973-334-1660
Fax Number	:	973-334-6085

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	DR. RANDY A SPECTOR
Credential	:	D.O.
Telephone Number	:	973-334-1660

Provider Enumeration Date	:	03/07/2007
Last Update Date	:	08/22/2020

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