Healthcare Provider Details

I. General information

NPI: 1104203272
Provider Name (Legal Business Name): YAAKOV ALLAEB
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: YAAKOV ALLAEB D.D.S

II. Dates (important events)

Enumeration Date: 04/28/2015
Last Update Date: 09/15/2022
Certification Date: 09/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

370 W PLEASANTVIEW AVE # 14A
HACKENSACK NJ
07601-8004
US

IV. Provider business mailing address

370 W PLEASANTVIEW AVE # 14A
HACKENSACK NJ
07601-8004
US

V. Phone/Fax

Practice location:
  • Phone: 201-373-2837
  • Fax:
Mailing address:
  • Phone: 201-373-2837
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number057291
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number12415
License Number StateCT
# 3
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number22DI02773700
License Number StateNJ

VII. Legacy identifiers

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: