MEDICARE: NORTH JERSEY DENTAL GROUP, PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332BC3200X	Customized Equipment (DME)
2	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1477796126
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTH JERSEY DENTAL GROUP, PA

Provider Business Mailing Address
First Line	:	450 LEWIS ST
Second Line	:
City	:	FORT LEE
State	:	NJ
Zip	:	07024-2912
Country	:	US
Telephone Number	:	201-461-4800
Fax Number	:	201-461-4448

Provider Business Practice Location Address
First Line	:	450 LEWIS ST
Second Line	:
City	:	FORT LEE
State	:	NJ
Zip	:	07024-2912
Country	:	US
Telephone Number	:	201-461-4800
Fax Number	:	201-461-4448

Authorized Official
Title or Position	:	OWNER/PRESIDENT
Name	:	DR. ALI WEISELBERG
Credential	:	DDS
Telephone Number	:	201-519-1385

Provider Enumeration Date	:	04/10/2009
Last Update Date	:	02/10/2025

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