Provider Demographics
NPI:1831362854
Name:JAMIE DIAMENT-GOLUB, DMD PC
Entity type:Organization
Organization Name:JAMIE DIAMENT-GOLUB, DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DIAMENT-GOLUB
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:201-944-7636
Mailing Address - Street 1:2185 LEMOINE AVE
Mailing Address - Street 2:
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-6036
Mailing Address - Country:US
Mailing Address - Phone:201-944-7636
Mailing Address - Fax:
Practice Address - Street 1:2185 LEMOINE AVE
Practice Address - Street 2:
Practice Address - City:FORT LEE
Practice Address - State:NJ
Practice Address - Zip Code:07024-6036
Practice Address - Country:US
Practice Address - Phone:201-944-7636
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-10
Last Update Date:2012-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY053459OtherNY DENTAL LICENSE
NJ22DI01630800OtherDENTAL LICENSE