Provider Demographics
NPI:1568522993
Name:EDISON-CLARK ORAL SURGERY ASSOCIATES
Entity Type:Organization
Organization Name:EDISON-CLARK ORAL SURGERY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:FRAYDA
Authorized Official - Middle Name:
Authorized Official - Last Name:KLEIMAN
Authorized Official - Suffix:
Authorized Official - Credentials:RDH
Authorized Official - Phone:732-548-7824
Mailing Address - Street 1:1857 OAK TREE RD
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-2779
Mailing Address - Country:US
Mailing Address - Phone:732-548-7824
Mailing Address - Fax:732-548-2051
Practice Address - Street 1:1857 OAK TREE RD
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820-2779
Practice Address - Country:US
Practice Address - Phone:732-548-7824
Practice Address - Fax:732-548-2051
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ168897Medicare ID - Type UnspecifiedGROUP