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General NPI Number Information
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NPI Number | 1144751835
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Entity Type | Organization
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Legal Business Name | ROBERT KORWIN DMD MICOI MAGD PA
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Dates
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Enumeration Date | 03/23/2017
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Last Update Date | 03/23/2017
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Provider Practice Location Address
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Address Line | 500 ROUTE 35 SUITE 562
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City | RED BANK
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State | NJ
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Zip | 07701-5038
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Country | US
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Telephone | 732-219-8900
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Fax |
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Provider Business Mailing Address
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Address Line | 500 ROUTE 35 SUITE 562
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City | RED BANK
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State | NJ
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Zip | 07701-5038
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ROBERT KORWIN
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Credential |
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Telephone | 732-219-8900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 22DI01390300
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License Number State | NJ
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