Provider Demographics
NPI:1760603468
Name:JONATHAN KOREN D.M.D.,P.C.
Entity Type:Organization
Organization Name:JONATHAN KOREN D.M.D.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KOREN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:908-429-0442
Mailing Address - Street 1:1130 US HIGHWAY 202
Mailing Address - Street 2:BLDG E-1
Mailing Address - City:RARITAN
Mailing Address - State:NJ
Mailing Address - Zip Code:08869-1490
Mailing Address - Country:US
Mailing Address - Phone:908-429-0442
Mailing Address - Fax:908-429-4107
Practice Address - Street 1:1130 US HIGHWAY 202
Practice Address - Street 2:BLDG E-1
Practice Address - City:RARITAN
Practice Address - State:NJ
Practice Address - Zip Code:08869-1490
Practice Address - Country:US
Practice Address - Phone:908-429-0442
Practice Address - Fax:908-429-4107
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI192261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ=========OtherTIN