Provider Demographics
NPI:1366654428
Name:EAST COAST ORAL AND MAXILLOFACIAL SURGEONS,PA
Entity Type:Organization
Organization Name:EAST COAST ORAL AND MAXILLOFACIAL SURGEONS,PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORAL SURGEON/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:TOOHEY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:609-465-9600
Mailing Address - Street 1:211 S MAIN ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:CAPE MAY COURT HOUSE
Mailing Address - State:NJ
Mailing Address - Zip Code:08210-2264
Mailing Address - Country:US
Mailing Address - Phone:609-465-9600
Mailing Address - Fax:609-465-0336
Practice Address - Street 1:211 S MAIN ST
Practice Address - Street 2:SUITE 201
Practice Address - City:CAPE MAY COURT HOUSE
Practice Address - State:NJ
Practice Address - Zip Code:08210-2264
Practice Address - Country:US
Practice Address - Phone:609-465-9600
Practice Address - Fax:609-465-0336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2008-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ0175111223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJFI93498Medicare UPIN