Provider Demographics
NPI:1245787258
Name:RIVERSIDE ORAL SURGERY-WESTWOOD LLC
Entity Type:Organization
Organization Name:RIVERSIDE ORAL SURGERY-WESTWOOD LLC
Other - Org Name:RIVERSIDE ORAL SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:M
Authorized Official - Last Name:AUERBACH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:201-487-6565
Mailing Address - Street 1:333 OLD HOOK RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WESTWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07675-3200
Mailing Address - Country:US
Mailing Address - Phone:201-487-6565
Mailing Address - Fax:201-487-4229
Practice Address - Street 1:333 OLD HOOK RD
Practice Address - Street 2:SUITE 100
Practice Address - City:WESTWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07675-3200
Practice Address - Country:US
Practice Address - Phone:201-487-6565
Practice Address - Fax:201-487-4229
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-07
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DIO22300001223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty