Healthcare Provider Details

I. General information

NPI: 1265240451
Provider Name (Legal Business Name): EISENBERGER AND MEISTER ORTHODONTICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2024
Last Update Date: 12/20/2024
Certification Date: 12/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

217 BROOK AVE STE B104
PASSAIC NJ
07055-3357
US

IV. Provider business mailing address

232 TERHUNE AVE # DOCK6
PASSAIC NJ
07055-3360
US

V. Phone/Fax

Practice location:
  • Phone: 973-862-3333
  • Fax:
Mailing address:
  • Phone: 973-862-3333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QS0112X
TaxonomyOral and Maxillofacial Surgery Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. MATTHEW ADAM MEISTER
Title or Position: PARTNER
Credential: DDS
Phone: 973-862-3333