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NPI Code Detail

MEDICARE: DR. ERIC FASS D.M.D.

MEDICARE: DR. ERIC FASS 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
11223G0001XGeneral Practice Dentistry10781NJ

General Provider Information

NPI Number : 1902977945
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ERIC FASS D.M.D.
Provider Business Mailing Address
First Line : 11-26 SADDLE RIVER RD
Second Line :
City : FAIR LAWN
State : NJ
Zip : 07410-5634
Country : US
Telephone Number : 201-791-3283
Fax Number : 201-791-0592
Provider Business Practice Location Address
First Line : 11-26 SADDLE RIVER RD
Second Line :
City : FAIR LAWN
State : NJ
Zip : 07410-5634
Country : US
Telephone Number : 201-791-3283
Fax Number : 201-791-0592
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/13/2006
Last Update Date : 07/08/2007

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