Provider Demographics
NPI:1871638684
Name:ALUF, MICHAEL VYACHESLAV (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:VYACHESLAV
Last Name:ALUF
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:VICHISLAV
Other - Middle Name:
Other - Last Name:ALUF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:306 MAIN ST
Mailing Address - Street 2:APT. 505
Mailing Address - City:RIDGEFIELD PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07660-1227
Mailing Address - Country:US
Mailing Address - Phone:201-925-5496
Mailing Address - Fax:
Practice Address - Street 1:289 E 149TH ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10451-5601
Practice Address - Country:US
Practice Address - Phone:718-742-7400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0525341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02778949Medicaid