Healthcare Provider Details

I. General information

NPI: 1699348540
Provider Name (Legal Business Name): WEIDENFELD ENDODONTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2021
Last Update Date: 08/22/2022
Certification Date: 04/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 MONTGOMERY ST FL 402
JERSEY CITY NJ
07302-3726
US

IV. Provider business mailing address

13-40 HENRIETTA CT
FAIR LAWN NJ
07410-5801
US

V. Phone/Fax

Practice location:
  • Phone: 201-332-0403
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State

VII. Legacy identifiers

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

VIII. Authorized Official

Name: ALEX WEIDENFELD
Title or Position: OWNER
Credential: DMD
Phone: 201-275-0262