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General NPI Number Information
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NPI Number | 1750878583
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Entity Type | Organization
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Legal Business Name | STEVEN A MENILLO, DDS & ASSOCIATES, LLC
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Dates
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Enumeration Date | 04/17/2018
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Last Update Date | 04/24/2018
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Provider Practice Location Address
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Address Line | 315 ROCHELLE AVE
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City | ROCHELLE PARK
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State | NJ
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Zip | 07662-3916
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Country | US
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Telephone | 201-843-1015
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Fax | 201-843-1036
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Provider Business Mailing Address
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Address Line | 315 ROCHELLE AVE
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City | ROCHELLE PARK
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State | NJ
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Zip | 07662-3916
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Country | US
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Telephone | 201-843-1015
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Fax | 201-843-1036
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Authorized Official
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Title or Position | OWNER
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Name | DR. STEVEN A MENILLO
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Credential | DDS
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Telephone | 201-843-1015
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 14867
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License Number State | NJ
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