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Provider Information for 1447539879

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: MALE

Individual NPI: 1447539879

Calendar   Last Updated:  2012-07-06
  Certification Date: 


Name Value
NPI 1447539879
Enumeration Date 2011-08-16
NPI Type 1 - Individual
Sole Proprietor YES
Status Active
Mailing Address 116 WASHINGTON ST APT 5
HOBOKEN, NJ 07030-4648
United States

Phone: 732-266-5298 | Fax:
View Map External Link
Primary Practice Address 10 W HANOVER AVE SUITE 101
RANDOLPH, NJ 07869-4221
United States

Phone: 973-895-4333 | 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 22DI02479300