Provider Demographics
NPI:1457650418
Name:HOBOKEN ORAL SURGERY GROUP
Entity Type:Organization
Organization Name:HOBOKEN ORAL SURGERY GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORAL SURGEON/ OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:IGNATIUS
Authorized Official - Middle Name:
Authorized Official - Last Name:SCALIA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:201-418-7300
Mailing Address - Street 1:231 WASHINGTON ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:HOBOKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07030-4738
Mailing Address - Country:US
Mailing Address - Phone:201-418-7300
Mailing Address - Fax:201-418-0102
Practice Address - Street 1:231 WASHINGTON ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:HOBOKEN
Practice Address - State:NJ
Practice Address - Zip Code:07030-4738
Practice Address - Country:US
Practice Address - Phone:201-418-7300
Practice Address - Fax:201-418-0102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-16
Last Update Date:2011-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ16993031223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJU54849Medicare UPIN