| NPI | 1073896809 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUZANNE WALTKE Office Manager 201-767-4001 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NJ 22DI02332400) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NJ 22DI01547211) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NJ 22DI01805400) | |
| Enumeration Date | 2011-09-28 |
| Last Update Date | 2011-09-28 |