Provider Demographics
NPI:1720492861
Name:MICHAEL R CORTESE D M D P A
Entity Type:Organization
Organization Name:MICHAEL R CORTESE D M D P A
Other - Org Name:PRINCETON PROSTHODONTICS
Other - Org Type:Other Name
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:CORTESE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-306-5551
Mailing Address - Street 1:311 WITHERSPOON ST
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08542-3454
Mailing Address - Country:US
Mailing Address - Phone:609-683-8282
Mailing Address - Fax:609-683-5767
Practice Address - Street 1:311 WITHERSPOON ST
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08542-3454
Practice Address - Country:US
Practice Address - Phone:609-683-8282
Practice Address - Fax:609-683-5767
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-17
Last Update Date:2014-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ32721223P0700X
332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0700XDental ProvidersDentistProsthodonticsGroup - Single Specialty
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized EquipmentGroup - Single Specialty