Provider Demographics
NPI:1922272269
Name:EAST BRUNSWICK NEW IMAGE DENTAL LLC
Entity Type:Organization
Organization Name:EAST BRUNSWICK NEW IMAGE DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAEJUNE
Authorized Official - Middle Name:
Authorized Official - Last Name:WOO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:732-432-8388
Mailing Address - Street 1:444 RYDERS LN
Mailing Address - Street 2:
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-2765
Mailing Address - Country:US
Mailing Address - Phone:732-432-8388
Mailing Address - Fax:732-432-8366
Practice Address - Street 1:444 RYDERS LN
Practice Address - Street 2:
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-2765
Practice Address - Country:US
Practice Address - Phone:732-432-8388
Practice Address - Fax:732-432-8366
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-17
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI20877122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty