Healthcare Provider Details

I. General information

NPI: 1477796126
Provider Name (Legal Business Name): NORTH JERSEY DENTAL GROUP, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2009
Last Update Date: 02/10/2025
Certification Date: 02/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 LEWIS ST
FORT LEE NJ
07024-2912
US

IV. Provider business mailing address

450 LEWIS ST
FORT LEE NJ
07024-2912
US

V. Phone/Fax

Practice location:
  • Phone: 201-461-4800
  • Fax: 201-461-4448
Mailing address:
  • Phone: 201-461-4800
  • Fax: 201-461-4448

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: DR. ALI WEISELBERG
Title or Position: OWNER/PRESIDENT
Credential: DDS
Phone: 201-519-1385