Provider Demographics
NPI:1437178449
Name:LIVINGSTON SUBSPECIALTY GROUP, P.A.
Entity Type:Organization
Organization Name:LIVINGSTON SUBSPECIALTY GROUP, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BOTTI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-597-1690
Mailing Address - Street 1:349 E NORTHFIELD RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039-4802
Mailing Address - Country:US
Mailing Address - Phone:973-597-0900
Mailing Address - Fax:973-597-0910
Practice Address - Street 1:349 E NORTHFIELD RD
Practice Address - Street 2:SUITE 200
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039-4802
Practice Address - Country:US
Practice Address - Phone:973-597-0900
Practice Address - Fax:973-597-0910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-19
Last Update Date:2015-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA045092207RH0003X
NJMA045093207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty
No207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3457109Medicaid
NJ034542Medicare PIN