MEDICARE: DR. SOFYA VAYNTRAUB DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	DI02416900	NJ

General Provider Information

NPI Number	:	1013148741
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SOFYA VAYNTRAUB DDS

Provider Business Mailing Address
First Line	:	27 DAMASCUS DR
Second Line	:
City	:	MARLBORO
State	:	NJ
Zip	:	07746-1950
Country	:	US
Telephone Number	:	732-261-2110
Fax Number	:

Provider Business Practice Location Address
First Line	:	30 MALL DR W
Second Line	:	SUITE 71 A
City	:	JERSEY CITY
State	:	NJ
Zip	:	07310-1615
Country	:	US
Telephone Number	:	201-626-2500
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/29/2009
Last Update Date	:	07/29/2009

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