1174734529 NPI number — NORTH JERSEY DENTAL LL, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174734529 NPI number — NORTH JERSEY DENTAL LL, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTH JERSEY DENTAL LL, LLC
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:
Provider Other Organization Name Type Code:
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:
1174734529
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
300 GORGE RD
Provider Second Line Business Mailing Address:
UNIT 54C
Provider Business Mailing Address City Name:
CLIFFSIDE PARK
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07010-2759
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
201-941-2921
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
411 ROUTE 46 EAST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DOVER
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07801
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-361-4200
Provider Business Practice Location Address Fax Number:
973-361-5445
Provider Enumeration Date:
05/25/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ERRICHIELLO
Authorized Official First Name:
DENNIS
Authorized Official Middle Name:
LOUIS
Authorized Official Title or Position:
DOCTOR
Authorized Official Telephone Number:
973-361-4200

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  22D101125400 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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