Provider Demographics
NPI:1376839860
Name:T AND D MEDICAL ASSOCIATES LLC
Entity Type:Organization
Organization Name:T AND D MEDICAL ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DORT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-280-0963
Mailing Address - Street 1:64 GRUMMAN AVE
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07112-2219
Mailing Address - Country:US
Mailing Address - Phone:973-280-0963
Mailing Address - Fax:973-926-6287
Practice Address - Street 1:132 WILLIAM ST
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07050-4065
Practice Address - Country:US
Practice Address - Phone:973-674-8985
Practice Address - Fax:973-674-8983
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-22
Last Update Date:2011-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty