=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033236377
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EPSTEIN, ELKIN, AND SARGISS ORTHODONTIC ASSOCIATES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/23/2007
-----------------------------------------------------
Last Update Date | 07/18/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 800 TENNENT RD
-----------------------------------------------------
City | MANALAPAN
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07726-8247
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-536-4422
-----------------------------------------------------
Fax | 732-536-3396
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 800 TENNENT RD
-----------------------------------------------------
City | MANALAPAN
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07726-8247
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-536-4422
-----------------------------------------------------
Fax | 732-536-3396
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. JOSHUA ZAK EPSTEIN
-----------------------------------------------------
Credential | D.M.D.
-----------------------------------------------------
Telephone | 732-536-4422
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223X0400X
-----------------------------------------------------
Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------