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1467 Highland Avenue Peapack NJ 07977 | |
(908) 234-0011 | |
(908) 234-9496 |
Full Name | |
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Speciality | Dentist |
Location | 1467 Highland Avenue, Peapack, New Jersey |
Authorized Official Name and Position | Steven Proctor (PRESIDENT) |
Authorized Official Contact | 9082340011 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Po Box 339 Peapack NJ 07977 Ph: (908) 234-0011 | 1467 Highland Avenue Peapack NJ 07977 Ph: (908) 234-0011 |
NPI Number | 1730142084 |
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Provider Enumeration Date | 04/08/2006 |
Last Update Date | 08/22/2020 |
Identifier | Type | State | Issuer |
---|---|---|---|
1730142084 | NPI | - | NPPES |
8620709 | Medicaid | NJ |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
122300000X | Dentist | 21801 (New Jersey) | Primary |