Provider Demographics
NPI:1962492157
Name:BELOK, GREGORY (DDS,MPH)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:
Last Name:BELOK
Suffix:
Gender:M
Credentials:DDS,MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2460 LEMOINE AVE
Mailing Address - Street 2:4TH FLOOR
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-6231
Mailing Address - Country:US
Mailing Address - Phone:201-461-0618
Mailing Address - Fax:
Practice Address - Street 1:MITSUWA MARKETPLACE 595 RIVER RD
Practice Address - Street 2:
Practice Address - City:EDGEWATER
Practice Address - State:NJ
Practice Address - Zip Code:07020-1104
Practice Address - Country:US
Practice Address - Phone:201-945-3202
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI010635001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice