Healthcare Provider Details

I. General information

NPI: 1477838175
Provider Name (Legal Business Name): DR DENTAL OF HACKENSACK PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2011
Last Update Date: 10/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 S RIVER ST
HACKENSACK NJ
07601-6651
US

IV. Provider business mailing address

500 S RIVER ST
HACKENSACK NJ
07601-6651
US

V. Phone/Fax

Practice location:
  • Phone: 201-641-5240
  • Fax: 201-641-5217
Mailing address:
  • Phone: 201-641-5240
  • Fax: 201-641-5217

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDI02484000
License Number StateNJ

VII. Legacy identifiers

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

VIII. Authorized Official

Name: DR. JULIA FAIGEL
Title or Position: OWNER
Credential: DMD
Phone: 781-789-0577