Provider Demographics
NPI:1154492007
Name:SITRIN, STEVEN E (DMD, PA)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:E
Last Name:SITRIN
Suffix:
Gender:M
Credentials:DMD, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 MAY ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08837-3264
Mailing Address - Country:US
Mailing Address - Phone:732-826-1095
Mailing Address - Fax:
Practice Address - Street 1:125 MAY ST
Practice Address - Street 2:SUITE 200
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08837-3264
Practice Address - Country:US
Practice Address - Phone:732-826-1095
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI 157621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ222035157OtherTAX ID
NJDI 15762OtherSTATE LICENSE NUMBER