Provider Demographics
NPI:1811918378
Name:GOLDFARB, SUSAN L (DMD,PC)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:L
Last Name:GOLDFARB
Suffix:
Gender:F
Credentials:DMD,PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1181 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-2015
Mailing Address - Country:US
Mailing Address - Phone:201-692-1510
Mailing Address - Fax:201-692-9840
Practice Address - Street 1:1181 RIVER RD
Practice Address - Street 2:
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-2015
Practice Address - Country:US
Practice Address - Phone:201-692-1510
Practice Address - Fax:201-692-9840
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2012-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI013118001223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY038870OtherNEW YORK STATE LICENSE
NJ1285654780OtherINCORPORATED NPI NUMBER