| Randolph Oral Pathology Associates, Llc | |
|
447 Route 10 Suite 5 Randolph NJ 07869-2132 | |
| (973) 328-0464 | |
| Not Available |
| Full Name | Randolph Oral Pathology Associates, Llc |
|---|---|
| Speciality | Dentist |
| Location | 447 Route 10, Randolph, New Jersey |
| Authorized Official Name and Position | Jessica L Wollenberg (SOLE MBR) |
| Authorized Official Contact | 9739459309 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Randolph Oral Pathology Associates, Llc 447 Route 10 Suite 5 Randolph NJ 07869-2132 Ph: (973) 328-0464 | Randolph Oral Pathology Associates, Llc 447 Route 10 Suite 5 Randolph NJ 07869-2132 Ph: (973) 328-0464 |
| NPI Number | 1053745117 |
|---|---|
| Provider Enumeration Date | 08/26/2013 |
| Last Update Date | 01/07/2014 |
| Medicare PECOS PAC ID | 4284861444 |
|---|---|
| Medicare Enrollment ID | O20131213000550 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053745117 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0106X | Dentist - Oral And Maxillofacial Pathology | 22DI02546000 (New Jersey) | Primary |
| Provider Name | Jessica L Wollenberg |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1770801888 PECOS PAC ID: 3870722333 Enrollment ID: I20140201000007 |
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