Provider Demographics
NPI:1285654780
Name:SUSAN L. GOLDFARB, DMD PC
Entity type:Organization
Organization Name:SUSAN L. GOLDFARB, DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PERIODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:GOLDFARB
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:201-692-1510
Mailing Address - Street 1:1181 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-2015
Mailing Address - Country:US
Mailing Address - Phone:201-692-1510
Mailing Address - Fax:201-692-9840
Practice Address - Street 1:1181 RIVER RD
Practice Address - Street 2:
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-2015
Practice Address - Country:US
Practice Address - Phone:201-692-1510
Practice Address - Fax:201-692-9840
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI013118001223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty