Provider Demographics
NPI:1528252327
Name:AMALGAMATED DENTAL CENTER OF EDISON
Entity type:Organization
Organization Name:AMALGAMATED DENTAL CENTER OF EDISON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:A
Authorized Official - Last Name:KOSOFSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-549-0002
Mailing Address - Street 1:2 DAYTON DR
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-3409
Mailing Address - Country:US
Mailing Address - Phone:732-549-0002
Mailing Address - Fax:732-549-3440
Practice Address - Street 1:2 DAYTON DR
Practice Address - Street 2:SUITE 2A
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820-3409
Practice Address - Country:US
Practice Address - Phone:732-549-0002
Practice Address - Fax:732-549-3440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-05
Last Update Date:2007-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI108401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty