Provider Demographics
NPI:1740361724
Name:CLIFTON ORAL & MAXILLOFACIAL SURGERY, P.A.
Entity type:Organization
Organization Name:CLIFTON ORAL & MAXILLOFACIAL SURGERY, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORAL SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:NICHOLAS
Authorized Official - Last Name:GORAB
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:973-778-7171
Mailing Address - Street 1:1439 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07013-4221
Mailing Address - Country:US
Mailing Address - Phone:973-778-7171
Mailing Address - Fax:973-916-0696
Practice Address - Street 1:1439 BROAD ST
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07013-4221
Practice Address - Country:US
Practice Address - Phone:973-778-7171
Practice Address - Fax:973-916-0696
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
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
NJ071245Medicare ID - Type UnspecifiedGROUP ID