MEDICARE: DR. DENTAL OF EDISON, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223D0001X	Public Health Dentistry	22DI02484000	NJ

General Provider Information

NPI Number	:	1013262583
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR. DENTAL OF EDISON, PC

Provider Business Mailing Address
First Line	:	561 US HIGHWAY 1
Second Line	:
City	:	EDISON
State	:	NJ
Zip	:	08817-4400
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	561 US HIGHWAY 1
Second Line	:
City	:	EDISON
State	:	NJ
Zip	:	08817-4400
Country	:	US
Telephone Number	:	917-656-5661
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JULIA FAIGEL
Credential	:
Telephone Number	:	917-656-5661

Provider Enumeration Date	:	07/19/2012
Last Update Date	:	07/19/2012

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