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NPI Code Detail

MEDICARE: DR. JARED GITTLEMAN D.M.D.

MEDICARE: DR. JARED GITTLEMAN 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
1122300000XDentistDS040782PA
2122300000XDentist22DI02643000NJ

General Provider Information

NPI Number : 1932558624
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JARED GITTLEMAN D.M.D.
Provider Business Mailing Address
First Line : 1319 LINCOLN AVE PO BOX 254
Second Line :
City : PROSPECT PARK
State : PA
Zip : 19076-1216
Country : US
Telephone Number : 610-532-5008
Fax Number :
Provider Business Practice Location Address
First Line : 1319 LINCOLN AVE
Second Line :
City : PROSPECT PARK
State : PA
Zip : 19076-1216
Country : US
Telephone Number : 610-532-5008
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/03/2016
Last Update Date : 06/23/2016

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