Provider Demographics
NPI:1558451344
Name:JOHN J DOOLAN DPM PA
Entity Type:Organization
Organization Name:JOHN J DOOLAN DPM PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:DOOLAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:201-836-2663
Mailing Address - Street 1:179 CEDAR LN
Mailing Address - Street 2:SUITE D-2
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-4304
Mailing Address - Country:US
Mailing Address - Phone:201-836-2663
Mailing Address - Fax:201-836-5819
Practice Address - Street 1:179 CEDAR LN
Practice Address - Street 2:SUITE D-2
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-4304
Practice Address - Country:US
Practice Address - Phone:201-836-2663
Practice Address - Fax:201-836-5819
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMD00264400261QP1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6078560001Medicare NSC
NYU82126Medicare UPIN