Provider Demographics
NPI:1962617480
Name:FEDERMAN, ROBERT JOEL (DDS)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:JOEL
Last Name:FEDERMAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2185 LEMOINE AVE STE 1K
Mailing Address - Street 2:
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-6030
Mailing Address - Country:US
Mailing Address - Phone:201-592-7727
Mailing Address - Fax:
Practice Address - Street 1:2185 LEMOINE AVE STE 1K
Practice Address - Street 2:
Practice Address - City:FORT LEE
Practice Address - State:NJ
Practice Address - Zip Code:07024-6030
Practice Address - Country:US
Practice Address - Phone:201-592-7727
Practice Address - Fax:201-592-1279
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22D101144100122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist