Healthcare Provider Details

I. General information

NPI: 1457933772
Provider Name (Legal Business Name): DAG NE PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2021
Last Update Date: 04/26/2021
Certification Date: 04/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 JACOBSTOWN RD
NEW EGYPT NJ
08533-1019
US

IV. Provider business mailing address

4 JACOBSTOWN RD
NEW EGYPT NJ
08533-1019
US

V. Phone/Fax

Practice location:
  • Phone: 609-758-8200
  • Fax: 609-758-8502
Mailing address:
  • Phone: 609-758-8200
  • Fax: 609-758-8502

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: RAFAELA NEDELEA
Title or Position: BILLING MANAGER
Credential:
Phone: 267-334-0082