MEDICARE: DR. JEFFREY WITTER PIKE 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	1223G0001X	General Practice Dentistry	22DI01198700	NJ

General Provider Information

NPI Number	:	1962520486
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEFFREY WITTER PIKE DMD

Provider Business Mailing Address
First Line	:	PO BOX 635
Second Line	:	27 HIGHWAY 202
City	:	FAR HILLS
State	:	NJ
Zip	:	07931-0635
Country	:	US
Telephone Number	:	908-234-0800
Fax Number	:	908-781-5731

Provider Business Practice Location Address
First Line	:	27 HIGHWAY 202
Second Line	:	2ND FLOOR
City	:	FAR HILLS
State	:	NJ
Zip	:	07931-0635
Country	:	US
Telephone Number	:	908-234-0800
Fax Number	:	908-718-5731

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

Provider Enumeration Date	:	03/26/2007
Last Update Date	:	07/08/2007

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