Provider Demographics
NPI:1376685743
Name:DR TEOFILO A DOUHAJRE JR PA
Entity Type:Organization
Organization Name:DR TEOFILO A DOUHAJRE JR PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TEOFILO
Authorized Official - Middle Name:A
Authorized Official - Last Name:DAUHAJRE
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:201-868-1200
Mailing Address - Street 1:7000 BOULEVARD EAST
Mailing Address - Street 2:
Mailing Address - City:GUTTENBERG
Mailing Address - State:NJ
Mailing Address - Zip Code:07093
Mailing Address - Country:US
Mailing Address - Phone:201-868-1200
Mailing Address - Fax:201-868-0064
Practice Address - Street 1:7000 BOULEVARD EAST
Practice Address - Street 2:
Practice Address - City:GUTTENBERG
Practice Address - State:NJ
Practice Address - Zip Code:07093
Practice Address - Country:US
Practice Address - Phone:201-868-1200
Practice Address - Fax:201-868-0064
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA41682207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ00888303Medicaid
NJ4418306OtherAETNA
NJ564G210OtherEMPIRE BC
NJ4418306OtherAETNA
NJ448275Medicare ID - Type Unspecified