1790878080 NPI number — EAST MADISON DENTAL CORP., P.C.

Table of content: (NPI 1790878080)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790878080 NPI number — EAST MADISON DENTAL CORP., P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EAST MADISON DENTAL CORP., P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
EAST MADISON DENTAL, P.C.
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1790878080
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/01/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
79 E MADISON AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DUMONT
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07628-2417
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
201-501-8282
Provider Business Mailing Address Fax Number:
201-501-8380

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
101 PIERMONT RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TENAFLY
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07670
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-501-8282
Provider Business Practice Location Address Fax Number:
201-501-8380
Provider Enumeration Date:
10/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
JAIN
Authorized Official First Name:
NARPAT
Authorized Official Middle Name:
S.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
201-501-8282

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  22DI02460200 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223E0200X , with the licence number: 22DI01950206 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223G0001X , with the licence number: 22DI01938000 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 1223P0221X , with the licence number: 22DI02660802 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223P0300X , with the licence number: 22DI01938209 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223P0700X , with the licence number: 22DI02277300 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223S0112X , with the licence number: 22DI02193003 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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