Provider Demographics
NPI:1962683334
Name:RIVERSIDE ORAL SURGERY-RIVER EDGE
Entity Type:Organization
Organization Name:RIVERSIDE ORAL SURGERY-RIVER EDGE
Other - Org Name:RIVERSIDE ORAL SURGERY
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:MICHAEL
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
Mailing Address - Street 2:SUITE 204
Mailing Address - City:RIVER EDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07661-1939
Mailing Address - Country:US
Mailing Address - Phone:201-487-6565
Mailing Address - Fax:201-487-4229
Practice Address - Street 1:130 KINDERKAMACK RD
Practice Address - Street 2:SUITE 204
Practice Address - City:RIVER EDGE
Practice Address - State:NJ
Practice Address - Zip Code:07661-1939
Practice Address - Country:US
Practice Address - Phone:201-487-6565
Practice Address - Fax:201-487-4229
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-14
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty