Provider Demographics
NPI:1255470019
Name:MICHAEL F DURANTE MD
Entity Type:Organization
Organization Name:MICHAEL F DURANTE MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:F
Authorized Official - Last Name:DURANTE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-667-8640
Mailing Address - Street 1:PO BOX 438
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07040-0438
Mailing Address - Country:US
Mailing Address - Phone:973-667-8640
Mailing Address - Fax:973-667-0401
Practice Address - Street 1:SUITE 214
Practice Address - Street 2:116 MILLBURN AVE
Practice Address - City:MILLBURN
Practice Address - State:NJ
Practice Address - Zip Code:07041-1940
Practice Address - Country:US
Practice Address - Phone:973-667-8640
Practice Address - Fax:973-667-0401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2007-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJE57882Medicare UPIN