=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548374861
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EMERSON FAMILY DENTAL CARE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/17/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 466 OLD HOOK RD SUITE 243
-----------------------------------------------------
City | EMERSON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07630
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-261-6688
-----------------------------------------------------
Fax | 201-261-4110
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 466 OLD HOOK RD SUITE 243
-----------------------------------------------------
City | EMERSON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07630
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-261-6688
-----------------------------------------------------
Fax | 201-261-4110
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DENTIST
-----------------------------------------------------
Name | DR. LINDA G MARORANO
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 201-261-6688
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 17589
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 18359
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------