Healthcare Provider Details

I. General information

NPI: 1255785085
Provider Name (Legal Business Name): ROBERT N MIRZA DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2016
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 COVE CT
SECAUCUS NJ
07094-2238
US

IV. Provider business mailing address

2 COVE CT
SECAUCUS NJ
07094-2238
US

V. Phone/Fax

Practice location:
  • Phone: 201-993-2704
  • Fax:
Mailing address:
  • Phone: 201-993-2704
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number22DI0267400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: