Provider Demographics
NPI:1285813907
Name:ELENA GERLIKHMAN
Entity Type:Organization
Organization Name:ELENA GERLIKHMAN
Other - Org Name:DENTAL DESIGN STUDIO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELENA
Authorized Official - Middle Name:
Authorized Official - Last Name:GERLIHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-966-4598
Mailing Address - Street 1:45 N BROAD ST
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07450-3856
Mailing Address - Country:US
Mailing Address - Phone:201-966-4598
Mailing Address - Fax:
Practice Address - Street 1:45 N BROAD ST
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450-3856
Practice Address - Country:US
Practice Address - Phone:201-966-4598
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-30
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ021543261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental