Healthcare Provider Details

I. General information

NPI: 1659669091
Provider Name (Legal Business Name): IMAD TAMIMI D.M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2011
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1054 CLIFTON AVE
CLIFTON NJ
07013-3638
US

IV. Provider business mailing address

1054 CLIFTON AVE
CLIFTON NJ
07013-3638
US

V. Phone/Fax

Practice location:
  • Phone: 973-625-4048
  • Fax: 973-625-1984
Mailing address:
  • Phone: 973-625-4048
  • Fax: 973-625-1984

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number22DI01875000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: