=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548470867
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JOEL D. ROSENKRANTZ, DDS, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/23/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 458 TAPPAN RD
-----------------------------------------------------
City | NORTHVALE
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07647-1416
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-768-0606
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 458 TAPPAN RD
-----------------------------------------------------
City | NORTHVALE
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07647-1416
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-768-0606
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DENTIST
-----------------------------------------------------
Name | DR. JOEL D. ROSENKRANTZ
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 201-768-0606
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 22DI01664100
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------