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Organization
MOUNTAINSIDE FAMILY PRACTICE ASSOCIATES - MERIT
Active
Organization
MOUNTAINSIDE FAMILY PRACTICE ASSOCIATES - MERIT
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BARRY DYKES MR. (C E O)
(973) 429-6000
Entity
Organization
Contact information
Practice address
799 BLOOMFIELD AVENUE, SUITE 201, VERONA, NJ 07044-0000
(973) 746-7050
(973) 857-2831
Mailing address
799 BLOOMFIELD AVE, SUITE 201, VERONA, NJ 07044-1367
(973) 746-7050
(973) 857-2831
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
—
—
207Q00000X
Family Medicine Physician
Primary
—
—
207RS0010X
Sports Medicine (Internal Medicine) Physician
—
—
208000000X
Pediatrics Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4138708
—
NJ
Enumeration date
03/08/2007
Last updated
11/21/2007
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