Provider Demographics
NPI:1669593521
Name:MONTVILLE ORAL SURGERY ASSOCIATES, L.L.C.
Entity type:Organization
Organization Name:MONTVILLE ORAL SURGERY ASSOCIATES, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:MCGOWAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-316-5757
Mailing Address - Street 1:150 RIVER RD STE H2
Mailing Address - Street 2:
Mailing Address - City:MONTVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07045-8922
Mailing Address - Country:US
Mailing Address - Phone:973-316-5757
Mailing Address - Fax:973-331-1443
Practice Address - Street 1:150 RIVER RD STE H2
Practice Address - Street 2:
Practice Address - City:MONTVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07045-8922
Practice Address - Country:US
Practice Address - Phone:973-316-5757
Practice Address - Fax:973-331-1443
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ261QS0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1C167241Medicare PIN