Healthcare Provider Details

I. General information

NPI: 1659560159
Provider Name (Legal Business Name): MARVIN M FAND DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/19/2007
Last Update Date: 12/21/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

138 BEACON ST
HAWORTH NJ
07641-1904
US

IV. Provider business mailing address

138 BEACON STR
HAWORTH NJ
07641
US

V. Phone/Fax

Practice location:
  • Phone: 201-384-3515
  • Fax: 201-384-3515
Mailing address:
  • Phone: 201-384-3515
  • Fax: 201-384-3515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number22D100677700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: