Provider Demographics
NPI:1477796126
Name:NORTH JERSEY DENTAL GROUP, PA
Entity Type:Organization
Organization Name:NORTH JERSEY DENTAL GROUP, PA
Other - Org Name:ALI WEISELBERG DDS PA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALI
Authorized Official - Middle Name:
Authorized Official - Last Name:WEISELBERG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:201-519-1385
Mailing Address - Street 1:450 LEWIS ST
Mailing Address - Street 2:
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-2912
Mailing Address - Country:US
Mailing Address - Phone:201-461-4800
Mailing Address - Fax:201-461-4448
Practice Address - Street 1:450 LEWIS ST
Practice Address - Street 2:
Practice Address - City:FORT LEE
Practice Address - State:NJ
Practice Address - Zip Code:07024-2912
Practice Address - Country:US
Practice Address - Phone:201-461-4800
Practice Address - Fax:201-461-4448
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-10
Last Update Date:2015-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI023265001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7378350001Medicare NSC