=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538202916
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RICHARD ALAN ZYM DMD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/15/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 282 US HIGHWAY 46
-----------------------------------------------------
City | PARSIPPANY
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07054-2313
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-808-4373
-----------------------------------------------------
Fax | 973-808-0173
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 46 INDEPENDENCE TRL
-----------------------------------------------------
City | TOTOWA
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07512-2801
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-389-0335
-----------------------------------------------------
Fax | 973-808-4373
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | DI18121
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------