Provider Demographics
NPI:1003059965
Name:ROCKAWAY FAMILY DENTAL LLC.
Entity Type:Organization
Organization Name:ROCKAWAY FAMILY DENTAL LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WEIMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:JIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-784-4749
Mailing Address - Street 1:200 E MAIN ST STE A&B
Mailing Address - Street 2:
Mailing Address - City:ROCKAWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:07866-3614
Mailing Address - Country:US
Mailing Address - Phone:973-784-4749
Mailing Address - Fax:973-784-4537
Practice Address - Street 1:200 E MAIN ST STE A&B
Practice Address - Street 2:
Practice Address - City:ROCKAWAY
Practice Address - State:NJ
Practice Address - Zip Code:07866-3614
Practice Address - Country:US
Practice Address - Phone:973-784-4749
Practice Address - Fax:973-784-4537
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-08
Last Update Date:2009-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI022171001223G0001X
NJ22DI022892001223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty