=====================================================
General NPI Number Information
=====================================================
NPI Number | 1891117560
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHASE DENTAL SLEEPCARE OF WESTFIELD
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/14/2014
-----------------------------------------------------
Last Update Date | 01/14/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 440 E BROAD ST
-----------------------------------------------------
City | WESTFIELD
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07090-2124
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 908-233-9280
-----------------------------------------------------
Fax | 908-233-1847
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 440 E BROAD ST
-----------------------------------------------------
City | WESTFIELD
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07090-2124
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 908-233-9280
-----------------------------------------------------
Fax | 908-233-1847
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DR/OWNER
-----------------------------------------------------
Name | ADAM E FERET
-----------------------------------------------------
Credential | DMD
-----------------------------------------------------
Telephone | 908-233-9280
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 22DI00841800
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------