CORY A. WANATICK,D.M.D.,P.A. (NPI# 1508924754) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1508924754 |
| Entity Type | Organization |
| Organization Name | CORY A. WANATICK,D.M.D.,P.A. |
| Practice Address |
1563 Parker Ave Fort Lee NJ 07024-7002 |
| Practice Telephone | 2014614133 |
| Practice Fax Number | 2014610796 |
| Mailing Telephone | 2014614133 |
| Mailing Fax Number | 2014610796 |
| Enumeration Date | 2006-12-04 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | DR. CORY A WANATICK (PRESIDENT) |
| Authorized Official Telephone | 2014614133 |
| Authorized Official Credential | D.M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223P0300X |
Dentist Specialization: Periodontics |
DI018012 | NJ | Dental Providers |
| Street Address |
1563 PARKER AVE |
| City | FORT LEE |
| State | NJ |
| Zip Code | 07024-7002 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043828726 | You S Jung | Pharmacist | 1275 15th Street Apt 2e, Fort Lee, NJ 07024 | 2020-07-17 |
| 1205316528 | Professional Orthopedic and Sports Therapy of Nj, LLC | Physical Therapist | 2200 Fletcher Ave Ste 505, Fort Lee, NJ 07024 | 2018-08-16 |
| 1194210138 | Hyunjoo Lee | Pharmacy | 168 Fletcher Ave, Fort Lee, NJ 07024 | 2018-06-22 |
| 1912423724 | Fort Lee Health Supplies | Durable Medical Equipment & Medical Supplies | 96 Linwood Plaza Rte 9 W, Fort Lee, NJ 07024 | 2017-08-15 |
| 1669997482 | Jinseok Woo | Acupuncturist | 6 Horizon Rd., Apt 2504, Fort Lee, NJ 07024 | 2017-08-14 |
| 1578083705 | Sheran Rey | Licensed Vocational Nurse | 6308 Hilltop Ct, Fort Lee, NJ 07024 | 2017-06-20 |
| 1558812909 | Jian Cui | Acupuncturist | 500 Linwood Drive Apt3c, Fort Lee, NJ 07024 | 2016-10-20 |
| 1013392919 | Yulong Yang | Internal Medicine | 2083 Center Ave Ste 2a, Fort Lee, NJ 07024 | 2015-07-22 |
| 1235561796 | Anthony Lucev | Student in an Organized Health Care Education/Training Program | 233 Harmon Ave, Fort Lee, NJ 07024 | 2013-08-06 |
| 1811331598 | Bridgeview Rehabilitation and Medical Arts Center | Physical Medicine & Rehabilitation | 454 Main Street 3rd Floor, Fort Lee, NJ 07024 | 2013-04-24 |
| Find all providers in zip 07024 | ||||
| Taxonomy Code | 1223P0300X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Periodontics |
| That specialty of dentistry which encompasses the prevention, diagnosis and treatment of diseases of the supporting and surrounding tissues of the teeth or their substitutes and the maintenance of the health, function and esthetics of these structures and tissues. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114559994 | Daniela Gurpegui Abud | Dentist | 100 Park Ave Apt Ph4j, Fort Lee, NJ 07024-3806 | 2020-02-10 |
| 1316179146 | Yoonkyung Oh | Dentist | 4205 Crest Ln, Fort Lee, NJ 07024-2233 | 2009-08-12 |
| 1134305808 | Raymond Zareh Darakjian | Dentist | 1211 Anderson Ave, Fort Lee, NJ 07024-1712 | 2008-01-12 |
| 1518168343 | Priyu Gupta | Dentist | 275 Hoym St, 2b, Fort Lee, NJ 07024-5646 | 2007-05-30 |
| 1841695822 | Joseph Wang | Dentist | 1625 Anderson Ave, Suite 302, Fort Lee, NJ 07024-2748 | 2014-11-03 |
| 1013183896 | Palisdes Periodontics | Dentist | 1530 Palisade Ave, Fort Lee, NJ 07024-5471 | 2008-05-01 |
| 1003098724 | Olga Michaud | Dentist | 301 Bridge Plz N, Fort Lee, NJ 07024-5059 | 2007-12-05 |
| 1548474547 | In Kim-yoo | Dentist | 810 Abbott Blvd, Suite 303, Fort Lee, NJ 07024-4151 | 2007-05-09 |
| 1992854673 | Philip Y. Kang | Dentist | 1567 Palisade Ave, #2a, Fort Lee, NJ 07024-6923 | 2007-01-10 |
| 1639241532 | Dayen Peter D Wang | Dentist | 1625 Anderson Ave, #302, Fort Lee, NJ 07024 | 2006-11-15 |
| Find all providers in FORT LEE | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.