Provider Demographics
NPI:1548483753
Name:EMELE, MICHAEL I (DDS)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:I
Last Name:EMELE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:513 35TH ST FL 1
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07087-2501
Mailing Address - Country:US
Mailing Address - Phone:201-430-9825
Mailing Address - Fax:201-430-9830
Practice Address - Street 1:513 35TH ST FL 1
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:NJ
Practice Address - Zip Code:07087-2501
Practice Address - Country:US
Practice Address - Phone:201-430-9825
Practice Address - Fax:201-430-9830
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI020218122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8157600Medicaid