John R Favetta M.D., P.a.

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

License

25MA03185400 Issued in NJ

Legal business name

JOHN R FAVETTA M.D., P.A.

Practice address

70 Ridge Rd
North Arlington, NJ 07031-6318

Phone

(201) 997-2332

Fax

(201) 997-6845

NPI assigned

Aug 23, 2006

Reactivated

Nov 18, 2014

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

John R Favetta, M.D.,P.A.

Title

Owner

Phone

(201) 997-2332

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156291200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1416268800000",
    "number": "1659487270",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "70 RIDGE RD",
            "city": "NORTH ARLINGTON",
            "state": "NJ",
            "postal_code": "070316318",
            "telephone_number": "201-997-2332",
            "fax_number": "201-997-6845"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "70 RIDGE RD",
            "city": "NORTH ARLINGTON",
            "state": "NJ",
            "postal_code": "070316318",
            "telephone_number": "201-997-2332",
            "fax_number": "201-997-6845"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JOHN R FAVETTA M.D., P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-23",
        "last_updated": "2014-11-18",
        "deactivation_date": "2014-11-04",
        "reactivation_date": "2014-11-18",
        "status": "A",
        "authorized_official_last_name": "FAVETTA",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "201-997-2332",
        "authorized_official_credential": "M.D.,P.A."
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Ophthalmology",
            "state": "NJ",
            "license": "25MA03185400",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3037908",
            "state": "NH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Ophthalmology Physician in North Arlington, NJ
• Providers in North Arlington, NJ by specialty
• Ophthalmology Physician in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.