Healthcare Provider Details

I. General information

NPI: 1356492623
Provider Name (Legal Business Name): JEFFREY DAVID GOLDFARB DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/15/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

280 CLIFFWOOD AVE
CLIFFWOOD NJ
07721-1128
US

IV. Provider business mailing address

19 DUNE RD
ASBURY PARK NJ
07712-3765
US

V. Phone/Fax

Practice location:
  • Phone: 732-583-3500
  • Fax:
Mailing address:
  • Phone: 732-695-1967
  • Fax: 732-441-0315

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number016717
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: