Provider Demographics
NPI:1952320244
Name:WEST ORANGE MEDICAL ASSOCIATES PC
Entity Type:Organization
Organization Name:WEST ORANGE MEDICAL ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:845-649-3864
Mailing Address - Street 1:PO BOX 3140
Mailing Address - Street 2:
Mailing Address - City:PORT JERVIS
Mailing Address - State:NY
Mailing Address - Zip Code:12771-0243
Mailing Address - Country:US
Mailing Address - Phone:845-649-3863
Mailing Address - Fax:845-856-5439
Practice Address - Street 1:111 WHEATFIELD DR
Practice Address - Street 2:SUITE 2
Practice Address - City:MILFORD
Practice Address - State:PA
Practice Address - Zip Code:18337-7697
Practice Address - Country:US
Practice Address - Phone:845-294-4350
Practice Address - Fax:845-294-4333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-18
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY33086207R00000X, 207R00000X
NY206842207RP1001X
PAMD061877L207RP1001X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAWE622951OtherPA BLUE SHIELD
NYCN5462OtherRR MEDICARE
PA045622PN3OtherPA MEDICARE
PA0018601600004OtherMEDICAID
NY02161270Medicaid
NJ7856407OtherNJ MEDICAID
NYW35011Medicare ID - Type Unspecified