Provider Demographics
NPI:1780879049
Name:GEORGE H. OEN M.D. & ROSE L.OEN M.D. PA
Entity type:Organization
Organization Name:GEORGE H. OEN M.D. & ROSE L.OEN M.D. PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROSE
Authorized Official - Middle Name:L
Authorized Official - Last Name:OEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-823-0166
Mailing Address - Street 1:781 KENNEDY BLVD
Mailing Address - Street 2:
Mailing Address - City:BAYONNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07002-2804
Mailing Address - Country:US
Mailing Address - Phone:201-823-0166
Mailing Address - Fax:201-858-4924
Practice Address - Street 1:781 KENNEDY BLVD
Practice Address - Street 2:
Practice Address - City:BAYONNE
Practice Address - State:NJ
Practice Address - Zip Code:07002-2804
Practice Address - Country:US
Practice Address - Phone:201-823-0166
Practice Address - Fax:201-858-4924
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-10
Last Update Date:2007-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA038079207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJC57055Medicare UPIN