Provider Demographics
NPI:1215021373
Name:GOLUB, JAMIE
Entity Type:Individual
Prefix:DR
First Name:JAMIE
Middle Name:
Last Name:GOLUB
Suffix:
Gender:F
Credentials:
Other - Prefix:PROF
Other - First Name:JAMIE
Other - Middle Name:
Other - Last Name:DIAMENT-GOLUB
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:2185 LEMOINE AVE
Mailing Address - Street 2:SUITE 1-JJ
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-6036
Mailing Address - Country:US
Mailing Address - Phone:201-944-7636
Mailing Address - Fax:201-944-9056
Practice Address - Street 1:2185 LEMOINE AVE
Practice Address - Street 2:SUITE 1-JJ
Practice Address - City:FORT LEE
Practice Address - State:NJ
Practice Address - Zip Code:07024-6036
Practice Address - Country:US
Practice Address - Phone:201-944-7636
Practice Address - Fax:201-944-9056
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ163081223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry