Provider Demographics
NPI:1932119211
Name:PARK AVENUE DENTAL OF NJ
Entity Type:Organization
Organization Name:PARK AVENUE DENTAL OF NJ
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KIRK
Authorized Official - Middle Name:A
Authorized Official - Last Name:KALOGIANNIS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:201-507-5000
Mailing Address - Street 1:155 PARK AVE
Mailing Address - Street 2:SUITE 207
Mailing Address - City:LYNDHURST
Mailing Address - State:NJ
Mailing Address - Zip Code:07071-1462
Mailing Address - Country:US
Mailing Address - Phone:201-507-5000
Mailing Address - Fax:201-507-5141
Practice Address - Street 1:155 PARK AVE
Practice Address - Street 2:SUITE 207
Practice Address - City:LYNDHURST
Practice Address - State:NJ
Practice Address - Zip Code:07071-1462
Practice Address - Country:US
Practice Address - Phone:201-507-5000
Practice Address - Fax:201-507-5141
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI-182301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty