Provider Demographics
NPI:1669545455
Name:MIDJERSEY ORAL AND MAXILLOFACIAL SURGERY,LLC
Entity type:Organization
Organization Name:MIDJERSEY ORAL AND MAXILLOFACIAL SURGERY,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:DR
Authorized Official - First Name:STUART
Authorized Official - Middle Name:H
Authorized Official - Last Name:MEYER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:732-566-7648
Mailing Address - Street 1:158 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MATAWAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07747-4104
Mailing Address - Country:US
Mailing Address - Phone:732-566-7648
Mailing Address - Fax:
Practice Address - Street 1:158 MAIN ST
Practice Address - Street 2:
Practice Address - City:MATAWAN
Practice Address - State:NJ
Practice Address - Zip Code:07747-4104
Practice Address - Country:US
Practice Address - Phone:732-566-7648
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-17
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
NJ=========OtherTAX ID NUMBER