Provider Demographics
NPI:1619124385
Name:RAHWAY DENTAL GROUP
Entity type:Organization
Organization Name:RAHWAY DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:OCCHIPINTI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:732-388-0314
Mailing Address - Street 1:692 SAINT GEORGES AVE
Mailing Address - Street 2:
Mailing Address - City:RAHWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:07065-2538
Mailing Address - Country:US
Mailing Address - Phone:732-388-0314
Mailing Address - Fax:732-388-3452
Practice Address - Street 1:692 SAINT GEORGES AVE
Practice Address - Street 2:
Practice Address - City:RAHWAY
Practice Address - State:NJ
Practice Address - Zip Code:07065-2538
Practice Address - Country:US
Practice Address - Phone:732-388-0314
Practice Address - Fax:732-388-3452
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-25
Last Update Date:2008-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI0187291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty