Provider Demographics
NPI:1376226308
Name:NJ ENDODONTICS GROUP BLOOMFIELD LLC
Entity Type:Organization
Organization Name:NJ ENDODONTICS GROUP BLOOMFIELD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NASSIM
Authorized Official - Middle Name:
Authorized Official - Last Name:KOHLY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:201-484-5404
Mailing Address - Street 1:22 OLD SHORT HILLS RD STE 208
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039-5605
Mailing Address - Country:US
Mailing Address - Phone:973-743-5500
Mailing Address - Fax:
Practice Address - Street 1:554 BLOOMFIELD AVE
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07003-3307
Practice Address - Country:US
Practice Address - Phone:973-281-4184
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTH JERSEY ENDODONTIC GROUP LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-08-08
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty