Provider Demographics
NPI:1689268427
Name:RIVERSIDE ORAL SURGERY - EDISON-CLARK
Entity Type:Organization
Organization Name:RIVERSIDE ORAL SURGERY - EDISON-CLARK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:M
Authorized Official - Last Name:AUERBACH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:201-487-6565
Mailing Address - Street 1:130 KINDERKAMACK RD STE 204
Mailing Address - Street 2:
Mailing Address - City:RIVER EDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07661-1931
Mailing Address - Country:US
Mailing Address - Phone:201-487-6565
Mailing Address - Fax:
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:201-487-6565
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-23
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty