Provider Demographics
NPI:1194748111
Name:NADDELMAN, FRED EUGENE (DDS)
Entity type:Individual
Prefix:DR
First Name:FRED
Middle Name:EUGENE
Last Name:NADDELMAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 STONY PATH DR
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08810-1623
Mailing Address - Country:US
Mailing Address - Phone:732-438-6967
Mailing Address - Fax:732-438-6597
Practice Address - Street 1:1315 STELTON RD
Practice Address - Street 2:
Practice Address - City:PISCATAWAY
Practice Address - State:NJ
Practice Address - Zip Code:08854-5265
Practice Address - Country:US
Practice Address - Phone:732-985-5600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI009169001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice