MEDICARE: DR. JAY LAWRENCE GREENFIELD DMD

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	1223P0300X	Periodontics	22DI02086800	NJ

General Provider Information

NPI Number	:	1790833804
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAY LAWRENCE GREENFIELD DMD

Provider Business Mailing Address
First Line	:	25 POMPTON AVE
Second Line	:	SUITE 101A
City	:	VERONA
State	:	NJ
Zip	:	07044-2941
Country	:	US
Telephone Number	:	973-239-2111
Fax Number	:	973-239-0880

Provider Business Practice Location Address
First Line	:	25 POMPTON AVE
Second Line	:	SUITE 101A
City	:	VERONA
State	:	NJ
Zip	:	07044-2941
Country	:	US
Telephone Number	:	973-239-2111
Fax Number	:	973-239-0880

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

Provider Enumeration Date	:	01/08/2007
Last Update Date	:	07/08/2007

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