Provider Demographics
NPI:1164874376
Name:RUTGERS UNIVERSITY DENTAL ASSOCIATES-NEW BRUNSWICK
Entity type:Organization
Organization Name:RUTGERS UNIVERSITY DENTAL ASSOCIATES-NEW BRUNSWICK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SR MGR BILLING & COLLECTIONS OFFICE
Authorized Official - Prefix:
Authorized Official - First Name:ROSEMARIE
Authorized Official - Middle Name:O
Authorized Official - Last Name:VACCARO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-972-8664
Mailing Address - Street 1:135 SOMERSET STREET
Mailing Address - Street 2:SUITE A
Mailing Address - City:NEW BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08901-2072
Mailing Address - Country:US
Mailing Address - Phone:732-235-5050
Mailing Address - Fax:732-220-0045
Practice Address - Street 1:135 SOMERSET STREET
Practice Address - Street 2:SUITE A
Practice Address - City:NEW BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08901-2072
Practice Address - Country:US
Practice Address - Phone:732-235-5050
Practice Address - Fax:732-220-0045
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-12
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02319600122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty