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Provider Information for 1811220296

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: 1811220296

Calendar   Last Updated:  2009-09-16
  Certification Date: 


Name Value
NPI 1811220296
Enumeration Date 2009-09-16
NPI Type 1 - Individual
Sole Proprietor NO
Status Active
Mailing Address 2403 STERLING BLVD
ENGLEWOOD, NJ 07631-4830
United States

Phone: 917-747-9324 | Fax:
View Map External Link
Primary Practice Address 751 TEANECK RD
TEANECK, NJ 07666-4242
United States

Phone: 201-837-1612 | 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 1223P0221X - Dentist Pediatric Dentistry NJ DI24126
No 122300000X - Dentist NY 054676