Provider Demographics
NPI:1982788501
Name:NORTH JERSEY CENTER FOR ORAL & MAXILLOFACIAL SURGERY PA
Entity Type:Organization
Organization Name:NORTH JERSEY CENTER FOR ORAL & MAXILLOFACIAL SURGERY PA
Other - Org Name:NORTH JERSEY ORAL AND MAXILLOFACIAL SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JERALD
Authorized Official - Middle Name:S
Authorized Official - Last Name:FRIEDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:201-692-7737
Mailing Address - Street 1:315 CEDAR LN
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-3442
Mailing Address - Country:US
Mailing Address - Phone:201-692-7737
Mailing Address - Fax:201-287-9716
Practice Address - Street 1:315 CEDAR LN
Practice Address - Street 2:2ND FL
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-3442
Practice Address - Country:US
Practice Address - Phone:201-692-7737
Practice Address - Fax:201-287-9716
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2013-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ084418Medicare PIN