=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306931290
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOSEPH AUGUSTINE LOBODA JR. D.M.D
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/04/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 687 KEARNY AVENUE
-----------------------------------------------------
City | KEARNY
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07032
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-997-5520
-----------------------------------------------------
Fax | 201-997-5532
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 77 WALNUT STREET
-----------------------------------------------------
City | LIVINGSTON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07039-2511
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-992-8355
-----------------------------------------------------
Fax | 973-992-4676
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223S0112X
-----------------------------------------------------
Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
-----------------------------------------------------
License Number | 22DI00889600
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------