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General NPI Number Information
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NPI Number | 1215552690
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Entity Type | Individual
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Provider Name | DR. REBECCA EIS
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Gender | Female
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Dates
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Enumeration Date | 06/11/2020
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Last Update Date | 06/11/2020
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Provider Practice Location Address
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Address Line | 1033 RIVER RD
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City | NEW MILFORD
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State | NJ
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Zip | 07646-3119
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Country | US
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Telephone | 201-836-7166
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Fax |
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Provider Business Mailing Address
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Address Line | 140 NORMA RD
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City | TEANECK
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State | NJ
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Zip | 07666-4234
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Country | US
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Telephone | 201-220-3036
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 22DI02676800
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 22DI02676800
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License Number State | NJ
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