Provider Demographics
NPI:1184864985
Name:PISCATAWAY FAMILY DENTAL, P.A.
Entity Type:Organization
Organization Name:PISCATAWAY FAMILY DENTAL, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:ABBATICCHIO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:609-978-8704
Mailing Address - Street 1:1310 CENTENNIAL AVNUE
Mailing Address - Street 2:UNIT 11
Mailing Address - City:PISCATAWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08854
Mailing Address - Country:US
Mailing Address - Phone:732-914-1039
Mailing Address - Fax:732-914-8472
Practice Address - Street 1:1310 CENTENNIAL AVNUE
Practice Address - Street 2:UNIT 11
Practice Address - City:PISCATAWAY
Practice Address - State:NJ
Practice Address - Zip Code:08854
Practice Address - Country:US
Practice Address - Phone:732-914-1039
Practice Address - Fax:732-914-8472
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-06
Last Update Date:2019-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI017432122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty