Provider Demographics
NPI:1952356792
Name:CAPE ATLANTIC ORAL & MAXILLOFACIAL SURGEONS, PA, INC
Entity Type:Organization
Organization Name:CAPE ATLANTIC ORAL & MAXILLOFACIAL SURGEONS, PA, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HARVEY
Authorized Official - Middle Name:C
Authorized Official - Last Name:STRAIR
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:609-465-4340
Mailing Address - Street 1:PO BOX 898
Mailing Address - Street 2:
Mailing Address - City:CAPE MAY COURT HOUSE
Mailing Address - State:NJ
Mailing Address - Zip Code:08210-0898
Mailing Address - Country:US
Mailing Address - Phone:609-465-4340
Mailing Address - Fax:609-465-5064
Practice Address - Street 1:101 STONE HARBOR BLVD
Practice Address - Street 2:
Practice Address - City:CAPE MAY COURT HOUSE
Practice Address - State:NJ
Practice Address - Zip Code:08210-2135
Practice Address - Country:US
Practice Address - Phone:609-465-4340
Practice Address - Fax:609-465-5064
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI090281223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ020666Medicare PIN