Provider Demographics
NPI:1205895224
Name:FENKART, DOUGLAS ROY (MD)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:ROY
Last Name:FENKART
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:TENAFLY PEDIATRICS, P.A.
Mailing Address - Street 2:32 FRANKLIN STREET
Mailing Address - City:TENAFLY
Mailing Address - State:NJ
Mailing Address - Zip Code:07670
Mailing Address - Country:US
Mailing Address - Phone:201-652-0300
Mailing Address - Fax:
Practice Address - Street 1:TENAFLY PEDIATRICS, P.A.
Practice Address - Street 2:32 FRANKLIN STREET
Practice Address - City:TENAFLY
Practice Address - State:NJ
Practice Address - Zip Code:07670
Practice Address - Country:US
Practice Address - Phone:201-569-2400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-20
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA059714208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ222110646OtherBUSINESS TAX ID #