Provider Demographics
NPI:1225134455
Name:NORTHFIELD DENTAL GROUP
Entity Type:Organization
Organization Name:NORTHFIELD DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BENEFITS
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:PISAURO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-736-0111
Mailing Address - Street 1:769 NORTHFIELD AVE
Mailing Address - Street 2:SUITE 154
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-1198
Mailing Address - Country:US
Mailing Address - Phone:973-736-0111
Mailing Address - Fax:973-325-6442
Practice Address - Street 1:769 NORTHFIELD AVE
Practice Address - Street 2:SUITE 154
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052-1198
Practice Address - Country:US
Practice Address - Phone:973-736-0111
Practice Address - Fax:973-325-6442
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-15
Last Update Date:2011-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ=========OtherFEDERAL TAX NUMBER
NJ=========OtherFEDERAL TAX NUMBER