Healthcare Provider Details

I. General information

NPI: 1942223227
Provider Name (Legal Business Name): DEREK J FAKTOR DMD MBA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 PLAZA 9
MANALAPAN NJ
07726-3010
US

IV. Provider business mailing address

345 E 56TH ST APT 6D
NEW YORK NY
10022-3744
US

V. Phone/Fax

Practice location:
  • Phone: 732-431-2080
  • Fax:
Mailing address:
  • Phone: 732-718-1063
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number050923
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDI021520
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: