=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467879536
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CENTER FOR SEDATION AND ORAL REHABILITATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/26/2014
-----------------------------------------------------
Last Update Date | 03/26/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 385 CRANBURY RD
-----------------------------------------------------
City | EAST BRUNSWICK
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08816-3000
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-254-0033
-----------------------------------------------------
Fax | 732-238-8869
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 385 CRANBURY RD
-----------------------------------------------------
City | EAST BRUNSWICK
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08816-3000
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-254-0033
-----------------------------------------------------
Fax | 732-238-8869
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DENTIST
-----------------------------------------------------
Name | NAHEL YANNI
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 732-254-0033
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223S0112X
-----------------------------------------------------
Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
-----------------------------------------------------
License Number | 22DI2208200
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------