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Provider Information for 1346572963

Please Note: Issuance of an NPI does not ensure or validate that the Health Care Provider is Licensed or Credentialed. For more information please refer to NPI: What You Need to Know


Gender: FEMALE

Individual NPI: 1346572963

Calendar   Last Updated:  2010-02-07
  Certification Date: 


Name Value
NPI 1346572963
Enumeration Date 2010-02-07
NPI Type 1 - Individual
Sole Proprietor YES
Status Active
Mailing Address 20 NEWPORT PKWY APT 2111
JERSEY CITY, NJ 07310-2301
United States

Phone: 917-420-0405 | Fax:
View Map External Link
Primary Practice Address 459 CHESTNUT ST
UNION, NJ 07083-9313
United States

Phone: 908-686-5868 | Fax:
View Map External Link
Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
Primary Taxonomy Selected Taxonomy State License Number
Yes 122300000X - Dentist NJ 22DI02420700