Provider Demographics
NPI:1801826987
Name:CAMERON A DARVISH DO MS PC
Entity Type:Organization
Organization Name:CAMERON A DARVISH DO MS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CAMERON
Authorized Official - Middle Name:A
Authorized Official - Last Name:DARVISH
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:973-942-1200
Mailing Address - Street 1:20-01 MAPLE AVENUE
Mailing Address - Street 2:
Mailing Address - City:FAIR LAWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07410
Mailing Address - Country:US
Mailing Address - Phone:201-791-8088
Mailing Address - Fax:201-791-2202
Practice Address - Street 1:401 HAMBURG TURNPIKE
Practice Address - Street 2:SUITE 309
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470
Practice Address - Country:US
Practice Address - Phone:973-942-1200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
G93573Medicare UPIN
NJ058630Medicare ID - Type Unspecified