Provider Demographics
NPI:1083632954
Name:FRED NADDELMAN, DDS, PA.
Entity Type:Organization
Organization Name:FRED NADDELMAN, DDS, PA.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FRED
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:NADDELMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:732-985-5600
Mailing Address - Street 1:4 STONY PATH DR
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08810-1623
Mailing Address - Country:US
Mailing Address - Phone:732-438-6967
Mailing Address - Fax:732-438-6597
Practice Address - Street 1:1315 STELTON RD
Practice Address - Street 2:
Practice Address - City:PISCATAWAY
Practice Address - State:NJ
Practice Address - Zip Code:08854-5265
Practice Address - Country:US
Practice Address - Phone:732-985-5600
Practice Address - Fax:732-985-1177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI009169001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty