Organization
NORTH HALEDON MEDICAL, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANTHONY BARRAVECCHIO (DELEGATED OFFICIAL)
(973) 942-6005
Entity
Organization
Contact information
Practice address
510 HAMBURG TPKE, WAYNE COMMONS, SUITE 101, WAYNE, NJ 07470-2025
(973) 942-6005
(973) 942-6009
Mailing address
510 HAMBURG TPKE, WAYNE COMMONS, SUITE 101, WAYNE, NJ 07470-2025
(973) 942-6005
(973) 942-6009
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
25MB06978600
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2016615002
AMERIHEALTH GROUP #
NJ
01
—
7305262
AETNA GROUP #
NJ
05
—
8644101
—
NJ
01
—
DC3972
RAILROAD MDCR GROUP #
NJ
Enumeration date
11/13/2006
Last updated
04/04/2013
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