Provider Demographics
NPI:1134320708
Name:ELBAUM, KROST & ELBAUM, DDS, PA
Entity Type:Organization
Organization Name:ELBAUM, KROST & ELBAUM, DDS, PA
Other - Org Name:CENTER FOR ORAL AND MAXILLOFACIAL SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RUBEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-531-8700
Mailing Address - Street 1:1125 STATE ROUTE 35
Mailing Address - Street 2:
Mailing Address - City:OCEAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07712-4043
Mailing Address - Country:US
Mailing Address - Phone:732-531-8700
Mailing Address - Fax:732-531-8775
Practice Address - Street 1:1125 STATE ROUTE 35
Practice Address - Street 2:
Practice Address - City:OCEAN
Practice Address - State:NJ
Practice Address - Zip Code:07712-4043
Practice Address - Country:US
Practice Address - Phone:732-531-8700
Practice Address - Fax:732-531-8775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-30
Last Update Date:2008-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ027425Medicare ID - Type Unspecified