Provider Demographics
NPI:1376194415
Name:HENRY THE DENTIST 1 NEW JERSEY P.A.
Entity Type:Organization
Organization Name:HENRY THE DENTIST 1 NEW JERSEY P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:BEN
Authorized Official - Last Name:RAPPAPORT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:551-999-2226
Mailing Address - Street 1:890 MOUNTAIN AVE STE 310
Mailing Address - Street 2:
Mailing Address - City:NEW PROVIDENCE
Mailing Address - State:NJ
Mailing Address - Zip Code:07974-1240
Mailing Address - Country:US
Mailing Address - Phone:551-999-2226
Mailing Address - Fax:908-926-2636
Practice Address - Street 1:890 MOUNTAIN AVE STE 310
Practice Address - Street 2:
Practice Address - City:NEW PROVIDENCE
Practice Address - State:NJ
Practice Address - Zip Code:07974-1240
Practice Address - Country:US
Practice Address - Phone:551-999-2226
Practice Address - Fax:908-926-2636
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HENRY THE DENTIST 1 NEW JERSEY P.A.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-09-20
Last Update Date:2019-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty