Healthcare Provider Details

I. General information

NPI: 1063621746
Provider Name (Legal Business Name): PEGAH AMAERI DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 09/27/2026
Certification Date: 09/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 MARKET ST
SADDLE BROOK NJ
07663-5400
US

IV. Provider business mailing address

173 W PROSPECT ST
WALDWICK NJ
07463-1332
US

V. Phone/Fax

Practice location:
  • Phone: 201-843-0041
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number06453701
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number22DIO2196100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: