Provider Demographics
NPI:1376807198
Name:MARCUS-PODHAIZER, CHERYL M (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHERYL
Middle Name:M
Last Name:MARCUS-PODHAIZER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 DAIBES CT
Mailing Address - Street 2:
Mailing Address - City:EDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:07020-1029
Mailing Address - Country:US
Mailing Address - Phone:201-224-2320
Mailing Address - Fax:
Practice Address - Street 1:21 S KINDERKAMACK RD
Practice Address - Street 2:
Practice Address - City:MONTVALE
Practice Address - State:NJ
Practice Address - Zip Code:07645-2112
Practice Address - Country:US
Practice Address - Phone:201-391-5565
Practice Address - Fax:201-391-8747
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-26
Last Update Date:2012-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI012721001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice