Healthcare Provider Details

I. General information

NPI: 1922001676
Provider Name (Legal Business Name): ROBERT E ROZENCWAIG D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 CLYDE RD STE 101-102
SOMERSET NJ
08873-5035
US

IV. Provider business mailing address

3 WENTWORTH DR
MANALAPAN NJ
07726-9360
US

V. Phone/Fax

Practice location:
  • Phone: 732-545-0001
  • Fax: 732-545-0004
Mailing address:
  • Phone: 732-792-3208
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDI020817
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: