Healthcare Provider Details

I. General information

NPI: 1437277258
Provider Name (Legal Business Name): FAINA L CHERKEZ DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 02/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 SUMMIT AVENUE
HACKENSACK NJ
07601
US

IV. Provider business mailing address

520 SUMMIT AVENUE
HACKENSACK NJ
07601
US

V. Phone/Fax

Practice location:
  • Phone: 201-488-9030
  • Fax: 201-488-9130
Mailing address:
  • Phone: 201-488-9030
  • Fax: 201-488-9130

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number1868300
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier6413501
Identifier TypeMEDICAID
Identifier StateNJ
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: