Provider Demographics
NPI:1467739714
Name:RARITAN BAY ORAL & MAXILLOFACIAL SURGERY PA
Entity Type:Organization
Organization Name:RARITAN BAY ORAL & MAXILLOFACIAL SURGERY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:W
Authorized Official - Last Name:FLUGRAD
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:732-442-1860
Mailing Address - Street 1:276 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:PERTH AMBOY
Mailing Address - State:NJ
Mailing Address - Zip Code:08861-4406
Mailing Address - Country:US
Mailing Address - Phone:732-442-1860
Mailing Address - Fax:732-442-8896
Practice Address - Street 1:276 HIGH ST
Practice Address - Street 2:
Practice Address - City:PERTH AMBOY
Practice Address - State:NJ
Practice Address - Zip Code:08861-4406
Practice Address - Country:US
Practice Address - Phone:732-442-1860
Practice Address - Fax:732-442-8896
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-14
Last Update Date:2012-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ127951223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1873407Medicaid
NJ1873407Medicaid