=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538376462
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FALIVENE AND FALIVENE DDS PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/17/2007
-----------------------------------------------------
Last Update Date | 05/29/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 232 NORWOOD AVE
-----------------------------------------------------
City | WEST LONG BRANCH
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07764
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-222-4694
-----------------------------------------------------
Fax | 732-222-1097
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 232 NORWOOD AVE STE B
-----------------------------------------------------
City | WEST LONG BRANCH
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07764-1860
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-222-4694
-----------------------------------------------------
Fax | 732-222-1097
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. RENEE M FALIVENE
-----------------------------------------------------
Credential | D.M.D.
-----------------------------------------------------
Telephone | 732-222-4694
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 22DI00633100
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------