Healthcare Provider Details

I. General information

NPI: 1457043556
Provider Name (Legal Business Name): DEXTER LOOS DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/25/2023
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 W 26TH ST FL 4
NEW YORK NY
10001-6975
US

IV. Provider business mailing address

25 ALDEN RD
MONTCLAIR NJ
07042-3305
US

V. Phone/Fax

Practice location:
  • Phone: 212-924-2510
  • Fax:
Mailing address:
  • Phone: 973-570-4563
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number346021
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: