Provider Demographics
NPI:1902133291
Name:AMZALLAG, EMILE (DDS)
Entity Type:Individual
Prefix:DR
First Name:EMILE
Middle Name:
Last Name:AMZALLAG
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 1:2100 LINWOOD AVE
Mailing Address - Street 2:#7-S
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-3186
Mailing Address - Country:US
Mailing Address - Phone:646-266-2642
Mailing Address - Fax:
Practice Address - Street 1:2100 LINWOOD AVE
Practice Address - Street 2:#7-S
Practice Address - City:FORT LEE
Practice Address - State:NJ
Practice Address - Zip Code:07024-3186
Practice Address - Country:US
Practice Address - Phone:646-266-2642
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-08
Last Update Date:2015-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0101591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice