Provider Demographics
NPI:1003052382
Name:DR. ANDREA HAYECK
Entity Type:Organization
Organization Name:DR. ANDREA HAYECK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/EMPLOYEE FOR DR ANDREA HAYE
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:MERILEE
Authorized Official - Last Name:JACOBSON
Authorized Official - Suffix:
Authorized Official - Credentials:DENTIST
Authorized Official - Phone:908-483-5300
Mailing Address - Street 1:15 SOUTH REID ST.
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:NJ
Mailing Address - Zip Code:07201
Mailing Address - Country:US
Mailing Address - Phone:908-558-1036
Mailing Address - Fax:
Practice Address - Street 1:801 N. WOOD AVE.
Practice Address - Street 2:ANDREA HAYECK
Practice Address - City:LINDEN
Practice Address - State:NJ
Practice Address - Zip Code:07036
Practice Address - Country:US
Practice Address - Phone:908-486-5300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-17
Last Update Date:2008-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI019830122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty