Provider Demographics
NPI:1396850665
Name:SIMONETTI, JOHN M (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:M
Last Name:SIMONETTI
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Gender:M
Credentials:MD
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Mailing Address - Street 1:233 MILLBURN AVE
Mailing Address - Street 2:
Mailing Address - City:MILLBURN
Mailing Address - State:NJ
Mailing Address - Zip Code:07041-1718
Mailing Address - Country:US
Mailing Address - Phone:908-790-6525
Mailing Address - Fax:973-378-4724
Practice Address - Street 1:75 E NORTHFIELD RD
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039-4532
Practice Address - Country:US
Practice Address - Phone:973-436-1410
Practice Address - Fax:973-378-4724
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2019-07-11
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA06116000207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJG32801Medicare UPIN