Provider Demographics
NPI:1740432137
Name:CENTRAL NEW JERSEY PROSTHODONTICS LLC
Entity Type:Organization
Organization Name:CENTRAL NEW JERSEY PROSTHODONTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:NAINESH
Authorized Official - Middle Name:A
Authorized Official - Last Name:DESAI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-983-3953
Mailing Address - Street 1:115 COPPERFIELD LN
Mailing Address - Street 2:
Mailing Address - City:METUCHEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08840-1234
Mailing Address - Country:US
Mailing Address - Phone:732-983-3953
Mailing Address - Fax:732-983-3953
Practice Address - Street 1:115 COPPERFIELD LN
Practice Address - Street 2:
Practice Address - City:METUCHEN
Practice Address - State:NJ
Practice Address - Zip Code:08840-1234
Practice Address - Country:US
Practice Address - Phone:732-983-3953
Practice Address - Fax:732-983-3953
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-16
Last Update Date:2008-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI023343001223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0700XDental ProvidersDentistProsthodonticsGroup - Single Specialty