Provider Demographics
NPI:1811906688
Name:BIJAK, TERESA (DMD)
Entity type:Individual
Prefix:DR
First Name:TERESA
Middle Name:
Last Name:BIJAK
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 1:311 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MANVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08835-1840
Mailing Address - Country:US
Mailing Address - Phone:908-253-3660
Mailing Address - Fax:
Practice Address - Street 1:311 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MANVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08835-1840
Practice Address - Country:US
Practice Address - Phone:908-253-3660
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI 203901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ22-3742604OtherTAX ID NUMBER