Provider Demographics
NPI:1043661440
Name:MOFS-NJ ORAL FACIAL SURGERY LLC
Entity Type:Organization
Organization Name:MOFS-NJ ORAL FACIAL SURGERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGEING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JANET
Authorized Official - Middle Name:
Authorized Official - Last Name:BODEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:646-360-4840
Mailing Address - Street 1:6118 RIVERDALE AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10471-1009
Mailing Address - Country:US
Mailing Address - Phone:646-360-4840
Mailing Address - Fax:212-202-6447
Practice Address - Street 1:901 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:HOBOKEN
Practice Address - State:NJ
Practice Address - Zip Code:07030-5105
Practice Address - Country:US
Practice Address - Phone:201-659-1600
Practice Address - Fax:212-202-6447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-27
Last Update Date:2018-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty