Provider Demographics
NPI:1629100466
Name:DEAN A DREZNER MD LLC
Entity Type:Organization
Organization Name:DEAN A DREZNER MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DREZNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:856-797-7970
Mailing Address - Street 1:5001 LINCOLN DR W
Mailing Address - Street 2:SUITE G
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-1522
Mailing Address - Country:US
Mailing Address - Phone:856-797-7970
Mailing Address - Fax:
Practice Address - Street 1:5001 LINCOLN DR W
Practice Address - Street 2:SUITE G
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-1522
Practice Address - Country:US
Practice Address - Phone:856-797-7970
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ=========OtherEMPLOYER ID NUMBER