Healthcare Provider Details

I. General information

NPI: 1598095416
Provider Name (Legal Business Name): SHAWN MICHAEL LAFKOWITZ DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/29/2009
Last Update Date: 12/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 LINCOLN HWY SUITE 6
EDISON NJ
08820-3962
US

IV. Provider business mailing address

134 E 22ND ST APT. 203
NEW YORK NY
10010-6316
US

V. Phone/Fax

Practice location:
  • Phone: 732-549-2340
  • Fax:
Mailing address:
  • Phone: 908-370-1536
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number22DI02381200
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: