Provider Demographics
NPI:1548861750
Name:COLUMBIA DENTAL OF ELIZABETH PA
Entity type:Organization
Organization Name:COLUMBIA DENTAL OF ELIZABETH PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COMPLIANCE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SCHANZE
Authorized Official - Middle Name:
Authorized Official - Last Name:ZAIDI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-403-0710
Mailing Address - Street 1:151 JEFFERSON AVENUE
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:NJ
Mailing Address - Zip Code:07201
Mailing Address - Country:US
Mailing Address - Phone:908-409-7300
Mailing Address - Fax:908-409-5071
Practice Address - Street 1:151 JEFFERSON AVENUE
Practice Address - Street 2:
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07201
Practice Address - Country:US
Practice Address - Phone:908-409-7300
Practice Address - Fax:908-409-5071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-04
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty