Provider Demographics
NPI:1114109360
Name:TOWNSHIP OF RANDOLPH
Entity Type:Organization
Organization Name:TOWNSHIP OF RANDOLPH
Other - Org Name:TOWNSHIP OF RANDOLPH HEALTH DEPARTMENT
Other - Org Type:Other Name
Authorized Official - Title/Position:HEALTH OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:CAPUTO
Authorized Official - Suffix:
Authorized Official - Credentials:HEALTH OFFICER
Authorized Official - Phone:973-989-7050
Mailing Address - Street 1:502 MILLBROOK AVE
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:NJ
Mailing Address - Zip Code:07869-3702
Mailing Address - Country:US
Mailing Address - Phone:973-989-7050
Mailing Address - Fax:973-989-0762
Practice Address - Street 1:502 MILLBROOK AVE
Practice Address - Street 2:
Practice Address - City:RANDOLPH
Practice Address - State:NJ
Practice Address - Zip Code:07869-3702
Practice Address - Country:US
Practice Address - Phone:973-989-7050
Practice Address - Fax:973-989-0762
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-29
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ251K00000X251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare