Provider Demographics
NPI:1295954071
Name:PAUL H. GOODMAN, D.D.S. AND JAY L. ROSENBERG, D.D.S., L.L.C.
Entity type:Organization
Organization Name:PAUL H. GOODMAN, D.D.S. AND JAY L. ROSENBERG, D.D.S., L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:HARRIS
Authorized Official - Last Name:GOODMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:609-641-1462
Mailing Address - Street 1:1511 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PLEASANTVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08232-3514
Mailing Address - Country:US
Mailing Address - Phone:609-641-1462
Mailing Address - Fax:609-641-5337
Practice Address - Street 1:1511 S MAIN ST
Practice Address - Street 2:
Practice Address - City:PLEASANTVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08232-3514
Practice Address - Country:US
Practice Address - Phone:609-641-1462
Practice Address - Fax:609-641-5337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI013771001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty