Provider Demographics
NPI:1073627626
Name:DAVID A. WORTH, M.D., P.A.
Entity Type:Organization
Organization Name:DAVID A. WORTH, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:A
Authorized Official - Last Name:WORTH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:908-686-6616
Mailing Address - Street 1:2376 MORRIS AVE
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-5707
Mailing Address - Country:US
Mailing Address - Phone:908-686-6616
Mailing Address - Fax:908-686-5806
Practice Address - Street 1:2376 MORRIS AVE
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083-5707
Practice Address - Country:US
Practice Address - Phone:908-686-6616
Practice Address - Fax:908-686-5806
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA02747700174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJC53574Medicare UPIN
NJW0149299Medicare ID - Type Unspecified