Healthcare Provider Details

I. General information

NPI: 1992791966
Provider Name (Legal Business Name): STEVEN ANTHONY DIRIENZO DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2005
Last Update Date: 05/29/2024
Certification Date: 05/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

925 BROADWAY
BAYONNE NJ
07002-3088
US

IV. Provider business mailing address

925 BROADWAY
BAYONNE NJ
07002-3088
US

V. Phone/Fax

Practice location:
  • Phone: 201-858-1400
  • Fax:
Mailing address:
  • Phone: 201-858-1400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDI021870
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: