Provider Demographics
NPI:1003195322
Name:HANDELMAN, MARISA LAUREN (DMD)
Entity type:Individual
Prefix:DR
First Name:MARISA
Middle Name:LAUREN
Last Name:HANDELMAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2346 ROUTE 9
Mailing Address - Street 2:
Mailing Address - City:HOWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07731-4017
Mailing Address - Country:US
Mailing Address - Phone:732-683-1130
Mailing Address - Fax:732-683-1132
Practice Address - Street 1:2346 ROUTE 9
Practice Address - Street 2:
Practice Address - City:HOWELL
Practice Address - State:NJ
Practice Address - Zip Code:07731-4017
Practice Address - Country:US
Practice Address - Phone:732-683-1130
Practice Address - Fax:732-683-1132
Is Sole Proprietor?:No
Enumeration Date:2011-08-04
Last Update Date:2013-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02495200122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist