=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245080019
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GAVRIEL RASKIN DMD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/25/2024
-----------------------------------------------------
Last Update Date | 10/13/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6418 BERGENLINE AVE FL 2
-----------------------------------------------------
City | WEST NEW YORK
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07093-1621
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-868-6400
-----------------------------------------------------
Fax | 201-868-6400
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 382 S PROSPECT AVE
-----------------------------------------------------
City | BERGENFIELD
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07621-3336
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-376-0674
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 22DI03118300
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------