MEDICARE: DR. PATRICIA ANN TORDIK D.M.D.

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	1223E0200X	Endodontics	22DI01769800	NJ
2	1223E0200X	Endodontics	DI 17698	NJ

General Provider Information

NPI Number	:	1104896117
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PATRICIA ANN TORDIK D.M.D.

Provider Business Mailing Address
First Line	:	318 OLD MILL RD
Second Line	:
City	:	SPRING LAKE
State	:	NJ
Zip	:	07762-1976
Country	:	US
Telephone Number	:	240-277-2876
Fax Number	:

Provider Business Practice Location Address
First Line	:	110 BERGEN ST
Second Line	:
City	:	NEWARK
State	:	NJ
Zip	:	07103-2495
Country	:	US
Telephone Number	:	973-972-1674
Fax Number	:	973-972-0328

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

Provider Enumeration Date	:	01/23/2006
Last Update Date	:	11/26/2019

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