Basic Information
| Provider Information | |||||||||
| NPI: | 1003321183 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MORRISTOWN MEDICAL CENTER FAMILY PRACITICE | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 416457 | ||||||||
| Address2: | |||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 022416457 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8443621735 | ||||||||
| FaxNumber: | 9732907495 | ||||||||
| Practice Location | |||||||||
| Address1: | 435 SOUTH ST | ||||||||
| Address2: | |||||||||
| City: | MORRISTOWN | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 079606422 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9739714222 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/11/2017 | ||||||||
| LastUpdateDate: | 12/11/2017 | ||||||||
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| AuthorizedOfficialLastName: | LYTWYN | ||||||||
| AuthorizedOfficialFirstName: | ALENA | ||||||||
| AuthorizedOfficialMiddleName: | MARIE | ||||||||
| AuthorizedOfficialTitleorPosition: | NURSE PRACTITIONER | ||||||||
| AuthorizedOfficialTelephone: | 9739714222 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | APN, NP-C | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2300X | 26NJ00756400 | NJ | Y | Ambulatory Health Care Facilities | Clinic/Center | Primary Care |
No ID Information.