Provider Demographics
NPI:1568648806
Name:TOWNSHIP OF WEST ORANGE
Entity type:Organization
Organization Name:TOWNSHIP OF WEST ORANGE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:HEALTH OFFICER TOWNSHIP OF W O
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:FONZINO
Authorized Official - Suffix:
Authorized Official - Credentials:HO
Authorized Official - Phone:973-325-4124
Mailing Address - Street 1:66 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-5404
Mailing Address - Country:US
Mailing Address - Phone:973-325-4124
Mailing Address - Fax:973-325-4005
Practice Address - Street 1:10 GASTON STREET
Practice Address - Street 2:WEST ORANGE HEALTH CENTER
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052
Practice Address - Country:US
Practice Address - Phone:973-325-4136
Practice Address - Fax:973-324-0206
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-17
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0029335Medicaid
NJ520396Medicare PIN
NJ520396Medicare Oscar/Certification