Provider Demographics
NPI:1841435336
Name:RASHBAUM, JUSTIN TODD (DMD)
Entity type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:TODD
Last Name:RASHBAUM
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1410 BROADWAY RM 3004
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10018-5030
Mailing Address - Country:US
Mailing Address - Phone:201-259-5273
Mailing Address - Fax:
Practice Address - Street 1:1410 BROADWAY
Practice Address - Street 2:SUITE 3004
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10018-5007
Practice Address - Country:US
Practice Address - Phone:212-391-1385
Practice Address - Fax:212-391-8540
Is Sole Proprietor?:No
Enumeration Date:2008-12-11
Last Update Date:2013-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY054478122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist