Healthcare Provider Details

I. General information

NPI: 1669935748
Provider Name (Legal Business Name): ROCHELLE MICHAELA FRUMKIN DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/07/2019
Last Update Date: 07/20/2021
Certification Date: 07/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 MADISON AVE
LAKEWOOD NJ
08701-3266
US

IV. Provider business mailing address

1015 S PARK AVE
HIGHLAND PARK NJ
08904-2954
US

V. Phone/Fax

Practice location:
  • Phone: 732-363-0177
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number22DI02767000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: