Healthcare Provider Details

I. General information

NPI: 1861567372
Provider Name (Legal Business Name): FRED PAUL APPELBAUM DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 FRANKLIN AVE
NUTLEY NJ
07110
US

IV. Provider business mailing address

500 FRANKLIN AVE
NUTLEY NJ
07110
US

V. Phone/Fax

Practice location:
  • Phone: 973-667-5507
  • Fax: 973-667-6150
Mailing address:
  • Phone: 973-667-5507
  • Fax: 973-667-6150

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number22DI01111000
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: