Provider Demographics
NPI:1043780687
Name:DERRICK ALLOWAY MEDICAL ARTS, LLC
Entity Type:Organization
Organization Name:DERRICK ALLOWAY MEDICAL ARTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DERRICK
Authorized Official - Middle Name:JASON
Authorized Official - Last Name:ALLOWAY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:201-207-9243
Mailing Address - Street 1:305 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:PATERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07504-2223
Mailing Address - Country:US
Mailing Address - Phone:201-207-9243
Mailing Address - Fax:888-627-5578
Practice Address - Street 1:305 PARK AVE
Practice Address - Street 2:
Practice Address - City:RUTHERFORD
Practice Address - State:NJ
Practice Address - Zip Code:07070-2748
Practice Address - Country:US
Practice Address - Phone:201-207-9243
Practice Address - Fax:888-627-5578
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-27
Last Update Date:2018-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies