Provider Demographics
NPI:1255456927
Name:OSIPUK, DARLENE M (MD)
Entity type:Individual
Prefix:
First Name:DARLENE
Middle Name:M
Last Name:OSIPUK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 BOULEVARD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:MOUNTAIN LAKES
Mailing Address - State:NJ
Mailing Address - Zip Code:07046-1742
Mailing Address - Country:US
Mailing Address - Phone:973-263-8282
Mailing Address - Fax:973-263-3141
Practice Address - Street 1:420 BOULEVARD
Practice Address - Street 2:SUITE 106
Practice Address - City:MOUNTAIN LAKES
Practice Address - State:NJ
Practice Address - Zip Code:07046-1742
Practice Address - Country:US
Practice Address - Phone:973-263-8282
Practice Address - Fax:973-263-3141
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA039999002084P0800X
NY148729-12084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ455149B6WMedicare ID - Type Unspecified
NJ532553Medicare ID - Type UnspecifiedGROUP MEDICARE NUMBER
NJC55684Medicare UPIN