Provider Demographics
NPI:1629792551
Name:N.J. ORAL & FACIAL SURGERY OF MONROE, LLC
Entity Type:Organization
Organization Name:N.J. ORAL & FACIAL SURGERY OF MONROE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NIKOLAY
Authorized Official - Middle Name:
Authorized Official - Last Name:LEVINTOV
Authorized Official - Suffix:
Authorized Official - Credentials:MD, DDS
Authorized Official - Phone:609-395-8300
Mailing Address - Street 1:12 WHITNEY DR
Mailing Address - Street 2:
Mailing Address - City:MARLBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:07746-1242
Mailing Address - Country:US
Mailing Address - Phone:646-651-6499
Mailing Address - Fax:
Practice Address - Street 1:18 CENTRE DR STE 202
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NJ
Practice Address - Zip Code:08831-1501
Practice Address - Country:US
Practice Address - Phone:609-395-8300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-04
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1316382641OtherNPI