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Provider Information for 1598977514



ROMAN KHODOSH DDS

Gender: MALE

Individual NPI: 1598977514

Calendar Last Updated: 2007-07-08

Details

Name Value
NPI 1598977514
Enumeration Date 2007-05-03
NPI Type 1 - Individual
Sole Proprietor NO
Status Active
Mailing Address 5918 BERGENLINE AVE SUITE 200
WEST NEW YORK, NJ 07093-1392
United States

Phone: 201-681-6555 | Fax: 201-861-2999
View Map External Link
Primary Practice Address 5918 BERGENLINE AVE SUITE 200
WEST NEW YORK, NJ 07093-1392
United States

Phone: 201-681-6555 | Fax: 201-861-2999
View Map External Link
Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
Taxonomy
Primary Taxonomy Selected Taxonomy State License Number
Yes 122300000X - Dentist NJ 22DI02185500