Healthcare Provider Details

I. General information

NPI: 1487567525
Provider Name (Legal Business Name): VALLABH DENTAL GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 PATERSON AVE APT 1A
HOBOKEN NJ
07030-6171
US

IV. Provider business mailing address

100 PATERSON AVE
HOBOKEN NJ
07030-6169
US

V. Phone/Fax

Practice location:
  • Phone: 201-716-0651
  • Fax:
Mailing address:
  • Phone: 201-716-0651
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number StateNULL

VIII. Authorized Official

Name: SHERRI FETHERMAN
Title or Position: OFFICE MANAGER
Credential:
Phone: 973-868-4131