Provider Demographics
NPI:1699922880
Name:DEITZ, JUSTINA M (DO)
Entity type:Individual
Prefix:
First Name:JUSTINA
Middle Name:M
Last Name:DEITZ
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:180 ENGLE ST
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-2507
Mailing Address - Country:US
Mailing Address - Phone:201-567-2050
Mailing Address - Fax:201-567-5070
Practice Address - Street 1:19-21 FAIR LAWN AVE
Practice Address - Street 2:
Practice Address - City:FAIR LAWN
Practice Address - State:NJ
Practice Address - Zip Code:07410-2331
Practice Address - Country:US
Practice Address - Phone:201-620-3390
Practice Address - Fax:201-693-9965
Is Sole Proprietor?:No
Enumeration Date:2008-08-19
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MB08466800207R00000X, 207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine