Healthcare Provider Details

I. General information

NPI: 1538080288
Provider Name (Legal Business Name): MADLEN RAED TOMMALIEH DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2026
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

397 HALEDON AVE
HALEDON NJ
07508-1551
US

IV. Provider business mailing address

93 PALISADE AVE APT 2C
CLIFFSIDE PARK NJ
07010-2043
US

V. Phone/Fax

Practice location:
  • Phone: 973-904-9611
  • Fax:
Mailing address:
  • Phone: 201-375-7888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number22DI03162500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: