# ROBERT DESIMONE FUNCTIONAL MEDICINE, INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1457150492
- **Authorized official:** ROBERT ANTHONY DESIMONE MD (OWNER)
- **Authorized official phone:** (973) 886-2195

## Contact information

- **Practice address:** 254 COLUMBIA TPKE STE 200, FLORHAM PARK, NJ 07932-1225
- **Practice address phone:** (973) 886-2195
- **Mailing address:** PO BOX 508, MONTVILLE, NJ 07045-0508
- **Mailing address phone:** (973) 886-2195

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM2500X | Medical Specialty Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 03/11/2025
- **Last updated:** 03/18/2025