Healthcare Provider Details

I. General information

NPI: 1720175912
Provider Name (Legal Business Name): JACK LEVI DDS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

185 CEDAR LN SUITE L7
TEANECK NJ
07666-4316
US

IV. Provider business mailing address

185 CEDAR LN SUITE L7
TEANECK NJ
07666-4316
US

V. Phone/Fax

Practice location:
  • Phone: 201-385-5400
  • Fax:
Mailing address:
  • Phone: 201-385-5400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number8340
License Number StateNJ

VII. Legacy identifiers

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

VIII. Authorized Official

Name: DR. JACK LEVI
Title or Position: PRESIDENT
Credential: DDS
Phone: 201-385-5400