Provider Demographics
NPI:1750878583
Name:STEVEN A MENILLO, DDS & ASSOCIATES, LLC
Entity type:Organization
Organization Name:STEVEN A MENILLO, DDS & ASSOCIATES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:MENILLO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:201-843-1015
Mailing Address - Street 1:315 ROCHELLE AVE
Mailing Address - Street 2:
Mailing Address - City:ROCHELLE PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07662-3916
Mailing Address - Country:US
Mailing Address - Phone:201-843-1015
Mailing Address - Fax:201-843-1036
Practice Address - Street 1:315 ROCHELLE AVE
Practice Address - Street 2:
Practice Address - City:ROCHELLE PARK
Practice Address - State:NJ
Practice Address - Zip Code:07662-3916
Practice Address - Country:US
Practice Address - Phone:201-843-1015
Practice Address - Fax:201-843-1036
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-17
Last Update Date:2018-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ14867261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental