Provider Demographics
NPI:1023500030
Name:JEFFREY D HAIMSON DMD
Entity type:Organization
Organization Name:JEFFREY D HAIMSON DMD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DMD, OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:HAIMSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-247-1758
Mailing Address - Street 1:9 FOX HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:MONTVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07045-9341
Mailing Address - Country:US
Mailing Address - Phone:201-247-1758
Mailing Address - Fax:
Practice Address - Street 1:1018 BROAD ST STE 4
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07003-2884
Practice Address - Country:US
Practice Address - Phone:201-247-1758
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-05
Last Update Date:2018-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22D107424001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty