Provider Demographics
NPI:1114340478
Name:MICRO TECH TRAINING CENTER
Entity Type:Organization
Organization Name:MICRO TECH TRAINING CENTER
Other - Org Name:JERSEY CITY DENTAL HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROFESSOR
Authorized Official - Prefix:PROF
Authorized Official - First Name:ALAA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOHSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-216-9901
Mailing Address - Street 1:684 NEWARK AVENUE
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07306
Mailing Address - Country:US
Mailing Address - Phone:201-216-9901
Mailing Address - Fax:
Practice Address - Street 1:684 NEWARK AVENUE
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306
Practice Address - Country:US
Practice Address - Phone:201-216-9901
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-22
Last Update Date:2016-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0506125Medicaid