Provider Demographics
NPI:1467510958
Name:FAIRFIELD MEDICAL GROUP
Entity Type:Organization
Organization Name:FAIRFIELD MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:DECORSO
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:973-575-5627
Mailing Address - Street 1:80 FAIRFIELD RD
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07004-2401
Mailing Address - Country:US
Mailing Address - Phone:973-575-5627
Mailing Address - Fax:973-575-5307
Practice Address - Street 1:80 FAIRFIELD RD
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07004-2401
Practice Address - Country:US
Practice Address - Phone:973-575-5627
Practice Address - Fax:973-575-5307
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty