Provider Demographics
NPI:1942719109
Name:FREDA ORTHODONTICS LLC
Entity Type:Organization
Organization Name:FREDA ORTHODONTICS LLC
Other - Org Name:OLD TAPPAN ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ORTHODONTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NICOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:FREDA
Authorized Official - Suffix:
Authorized Official - Credentials:DMDS
Authorized Official - Phone:908-295-6508
Mailing Address - Street 1:180 OLD TAPPAN RD STE 1A
Mailing Address - Street 2:
Mailing Address - City:OLD TAPPAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07675-7052
Mailing Address - Country:US
Mailing Address - Phone:201-768-0018
Mailing Address - Fax:
Practice Address - Street 1:180 OLD TAPPAN RD STE 1A
Practice Address - Street 2:
Practice Address - City:OLD TAPPAN
Practice Address - State:NJ
Practice Address - Zip Code:07675-7052
Practice Address - Country:US
Practice Address - Phone:201-768-0018
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI025937001223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty