Provider Demographics
NPI:1073685533
Name:ROSELLE PARK DENTAL ASSOC LLC
Entity Type:Organization
Organization Name:ROSELLE PARK DENTAL ASSOC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:DR
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:C
Authorized Official - Last Name:GELBMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:908-245-1745
Mailing Address - Street 1:141 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:ROSELLE PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07204-2261
Mailing Address - Country:US
Mailing Address - Phone:908-245-1745
Mailing Address - Fax:
Practice Address - Street 1:141 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:ROSELLE PARK
Practice Address - State:NJ
Practice Address - Zip Code:07204-2261
Practice Address - Country:US
Practice Address - Phone:908-245-1745
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty