Healthcare Provider Details

I. General information

NPI: 1598767469
Provider Name (Legal Business Name): RICHARD C.BLUMENFELD D.D.S.;P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

279 BROWERTOWN RD
WEST PATERSON NJ
07424-2663
US

IV. Provider business mailing address

279 BROWERTOWN RD
WEST PATERSON NJ
07424-2663
US

V. Phone/Fax

Practice location:
  • Phone: 973-256-3366
  • Fax: 972-256-6579
Mailing address:
  • Phone: 973-256-3366
  • Fax: 972-256-6579

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number22D100824300
License Number StateNJ

VIII. Authorized Official

Name: DR. RICHARD C BLUMENFELD
Title or Position: PRESIDENT
Credential: D.D.S.
Phone: 973-256-3366