Provider Demographics
NPI:1376882324
Name:NORTH JERSEY MAXILLO-FACIAL SERVICES LLC
Entity Type:Organization
Organization Name:NORTH JERSEY MAXILLO-FACIAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR SAMUEL ROMANO
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ROMANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-377-7088
Mailing Address - Street 1:120 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:NJ
Mailing Address - Zip Code:07940-1559
Mailing Address - Country:US
Mailing Address - Phone:973-377-7088
Mailing Address - Fax:
Practice Address - Street 1:120 PARK AVE
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:NJ
Practice Address - Zip Code:07940-1559
Practice Address - Country:US
Practice Address - Phone:973-377-7088
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-12
Last Update Date:2013-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI15181174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty