Provider Demographics
NPI:1437683075
Name:DA MEDICAL ARTS
Entity Type:Organization
Organization Name:DA MEDICAL ARTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DERRICK
Authorized Official - Middle Name:JASON
Authorized Official - Last Name:ALLOWAY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:201-207-9243
Mailing Address - Street 1:305 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:RUTHERFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07070-2748
Mailing Address - Country:US
Mailing Address - Phone:201-207-9243
Mailing Address - Fax:888-627-5578
Practice Address - Street 1:305 PARK AVE
Practice Address - Street 2:
Practice Address - City:RUTHERFORD
Practice Address - State:NJ
Practice Address - Zip Code:07070-2748
Practice Address - Country:US
Practice Address - Phone:201-207-9243
Practice Address - Fax:888-627-5578
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-19
Last Update Date:2017-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0161772Medicaid