Provider Demographics
NPI:1073973939
Name:SOUTH BERGEN ORAL MAXILLOFACIAL SURGERY LLC
Entity Type:Organization
Organization Name:SOUTH BERGEN ORAL MAXILLOFACIAL SURGERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ESHANSH
Authorized Official - Middle Name:
Authorized Official - Last Name:ARORA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-935-4577
Mailing Address - Street 1:422 STUYVESANT AVE
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:LYNDHURST
Mailing Address - State:NJ
Mailing Address - Zip Code:07071-2326
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:422 STUYVESANT AVE
Practice Address - Street 2:1ST FLOOR
Practice Address - City:LYNDHURST
Practice Address - State:NJ
Practice Address - Zip Code:07071-2326
Practice Address - Country:US
Practice Address - Phone:201-935-4577
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-04
Last Update Date:2016-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI022854051223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty