Basic Information
| Provider Information | |||||||||
| NPI: | 1477663862 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ALMOG | ||||||||
| FirstName: | DOV | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 7 CLIFF RD | ||||||||
| Address2: | #C1 | ||||||||
| City: | WEST PATERSON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 074244221 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9732000355 | ||||||||
| FaxNumber: | 9732000355 | ||||||||
| Practice Location | |||||||||
| Address1: | VA NEW JERSEY HEALTH CARE SYSTEM | ||||||||
| Address2: | 385 TREMONT AVENUE | ||||||||
| City: | EAST ORANGE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 07018 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9736761000 | ||||||||
| FaxNumber: | 9733957019 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/30/2006 | ||||||||
| LastUpdateDate: | 12/14/2007 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | M | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223P0700X | 043694-1 | NY | Y | Dental Providers | Dentist | Prosthodontics |
ID Information
| ID | Type | State | Issuer | Description | BA9891412 | 01 | NY | DEA | OTHER |