Provider Demographics
NPI:1114152766
Name:ORAL & MAXILLOFACIAL SURGERY INSTITUTE PC
Entity Type:Organization
Organization Name:ORAL & MAXILLOFACIAL SURGERY INSTITUTE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:DIRINZO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:973-643-1130
Mailing Address - Street 1:50 PARK PLACE
Mailing Address - Street 2:STE # 1540
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07102
Mailing Address - Country:US
Mailing Address - Phone:973-643-1130
Mailing Address - Fax:973-643-1537
Practice Address - Street 1:50 PARK PLACE
Practice Address - Street 2:STE # 1540
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07102
Practice Address - Country:US
Practice Address - Phone:973-643-1130
Practice Address - Fax:973-643-1537
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-27
Last Update Date:2009-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8975809Medicaid