Healthcare Provider Details

I. General information

NPI: 1215077037
Provider Name (Legal Business Name): BEN M KERSHENBAUM II D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

185 LINDEN ST
HACKENSACK NJ
07601-4671
US

IV. Provider business mailing address

1230 W LAURELTON PKWY
TEANECK NJ
07666-2748
US

V. Phone/Fax

Practice location:
  • Phone: 201-343-3555
  • Fax: 201-343-8382
Mailing address:
  • Phone: 201-837-1015
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number16515
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: