Provider Demographics
NPI:1114789419
Name:M & A PROFESSIONAL SERVICE LLC
Entity Type:Organization
Organization Name:M & A PROFESSIONAL SERVICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:NAN-YI
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:908-436-0100
Mailing Address - Street 1:1000 S ELMORA AVE STE 1E
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:NJ
Mailing Address - Zip Code:07202-3100
Mailing Address - Country:US
Mailing Address - Phone:908-436-1000
Mailing Address - Fax:908-436-0295
Practice Address - Street 1:1000 S ELMORA AVE STE 1E
Practice Address - Street 2:
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07202-3100
Practice Address - Country:US
Practice Address - Phone:908-436-1000
Practice Address - Fax:908-436-0295
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-23
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty