Provider Demographics
NPI:1215107602
Name:JAN GLADSTONE & ROBERT DORSKY,DMD
Entity type:Organization
Organization Name:JAN GLADSTONE & ROBERT DORSKY,DMD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:PENARANDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-867-0900
Mailing Address - Street 1:2400 BERGENLINE AVE
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07087-3677
Mailing Address - Country:US
Mailing Address - Phone:201-867-0900
Mailing Address - Fax:201-867-2352
Practice Address - Street 1:2400 BERGENLINE AVE
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:NJ
Practice Address - Zip Code:07087-3677
Practice Address - Country:US
Practice Address - Phone:201-867-0900
Practice Address - Fax:201-867-2352
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-03
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ143441223G0001X
NJ136281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3208508Medicaid