Healthcare Provider Details

I. General information

NPI: 1699630954
Provider Name (Legal Business Name): NATHAN LIGHT DMD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2025
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 DOWNTOWN DR STE 109
MONSEY NY
10952-3849
US

IV. Provider business mailing address

327 WARWICK AVE
TEANECK NJ
07666-3037
US

V. Phone/Fax

Practice location:
  • Phone: 201-509-0737
  • Fax:
Mailing address:
  • Phone: 201-509-0737
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. NATHAN LIGHT
Title or Position: OWNER
Credential: DMD
Phone: 201-509-0737