Provider Demographics
NPI:1457468332
Name:WEST JERSEY ORAL & MAXILLOFACIAL SURGEONS, P.C.
Entity Type:Organization
Organization Name:WEST JERSEY ORAL & MAXILLOFACIAL SURGEONS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:D.M.D. ORAL SURGEON
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:J
Authorized Official - Last Name:SANSEVERE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:908-806-7060
Mailing Address - Street 1:6 SAND HILL RD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:FLEMINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08822-4946
Mailing Address - Country:US
Mailing Address - Phone:908-806-7060
Mailing Address - Fax:908-782-1235
Practice Address - Street 1:6 SAND HILL RD
Practice Address - Street 2:SUITE 301
Practice Address - City:FLEMINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08822-4946
Practice Address - Country:US
Practice Address - Phone:908-806-7060
Practice Address - Fax:908-782-1235
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ174071223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJU51489Medicare UPIN
NJ533235Medicare ID - Type Unspecified