Provider Demographics
NPI:1144751835
Name:ROBERT KORWIN DMD MICOI MAGD PA
Entity Type:Organization
Organization Name:ROBERT KORWIN DMD MICOI MAGD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:KORWIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-219-8900
Mailing Address - Street 1:500 ROUTE 35
Mailing Address - Street 2:SUITE 562
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-5038
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:500 ROUTE 35
Practice Address - Street 2:SUITE 562
Practice Address - City:RED BANK
Practice Address - State:NJ
Practice Address - Zip Code:07701-5038
Practice Address - Country:US
Practice Address - Phone:732-219-8900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-23
Last Update Date:2017-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI013903001223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty