Provider Demographics
NPI:1548373012
Name:MIRIAM T. FURLONG, DMD, PC
Entity type:Organization
Organization Name:MIRIAM T. FURLONG, DMD, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MIRIAM
Authorized Official - Middle Name:TYGIER
Authorized Official - Last Name:FURLONG
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:732-942-8400
Mailing Address - Street 1:2200 W COUNTY LINE RD STE 3
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:NJ
Mailing Address - Zip Code:08527-2277
Mailing Address - Country:US
Mailing Address - Phone:732-942-8400
Mailing Address - Fax:732-942-6505
Practice Address - Street 1:2200 W COUNTY LINE RD STE 3
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:NJ
Practice Address - Zip Code:08527-2277
Practice Address - Country:US
Practice Address - Phone:732-942-8400
Practice Address - Fax:732-942-6505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI202481223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty