Provider Demographics
NPI:1053062539
Name:OSTEOPATHIC FAMILY MEDICINE OF NORTHERN NJ LLC
Entity Type:Organization
Organization Name:OSTEOPATHIC FAMILY MEDICINE OF NORTHERN NJ LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:DEFEO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:551-815-1000
Mailing Address - Street 1:541 CEDAR HILL AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:WYCKOFF
Mailing Address - State:NJ
Mailing Address - Zip Code:07481-2133
Mailing Address - Country:US
Mailing Address - Phone:551-815-1000
Mailing Address - Fax:551-815-1001
Practice Address - Street 1:541 CEDAR HILL AVE
Practice Address - Street 2:
Practice Address - City:WYCKOFF
Practice Address - State:NJ
Practice Address - Zip Code:07481-2150
Practice Address - Country:US
Practice Address - Phone:551-500-5708
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-16
Last Update Date:2022-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Single Specialty