Provider Demographics
NPI:1659016293
Name:NJ FACE DOCTOR PC
Entity Type:Organization
Organization Name:NJ FACE DOCTOR PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TAL
Authorized Official - Middle Name:
Authorized Official - Last Name:DAGAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-660-6644
Mailing Address - Street 1:265 PURDUE CT
Mailing Address - Street 2:
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07652-1642
Mailing Address - Country:US
Mailing Address - Phone:917-660-6644
Mailing Address - Fax:866-401-0389
Practice Address - Street 1:55 MEADOWLANDS PKWY
Practice Address - Street 2:
Practice Address - City:SECAUCUS
Practice Address - State:NJ
Practice Address - Zip Code:07094-2977
Practice Address - Country:US
Practice Address - Phone:917-660-6644
Practice Address - Fax:866-401-0389
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-28
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic SurgeryGroup - Single Specialty