Healthcare Provider Details

I. General information

NPI: 1659016293
Provider Name (Legal Business Name): NJ FACE DOCTOR PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

55 MEADOWLANDS PKWY
SECAUCUS NJ
07094-2977
US

IV. Provider business mailing address

265 PURDUE CT
PARAMUS NJ
07652-1642
US

V. Phone/Fax

Practice location:
  • Phone: 917-660-6644
  • Fax: 866-401-0389
Mailing address:
  • Phone: 917-660-6644
  • Fax: 866-401-0389

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: TAL DAGAN
Title or Position: PRESIDENT
Credential: MD
Phone: 917-660-6644