Provider Demographics
NPI:1669672754
Name:CHOI, JAE (DDS)
Entity Type:Individual
Prefix:
First Name:JAE
Middle Name:
Last Name:CHOI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 E PALISADE AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ENGLEWOOD CLIFFS
Mailing Address - State:NJ
Mailing Address - Zip Code:07632-3055
Mailing Address - Country:US
Mailing Address - Phone:201-541-0090
Mailing Address - Fax:
Practice Address - Street 1:701 E PALISADE AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:ENGLEWOOD CLIFFS
Practice Address - State:NJ
Practice Address - Zip Code:07632-3055
Practice Address - Country:US
Practice Address - Phone:201-541-0090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-18
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0504841223G0001X
NJ22DI022382001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02413418Medicaid