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BERGEN ORAL SURGERY GROUP PA NPI 1316024458


NPI Information

NPI: 1316024458
Provider Name: BERGEN ORAL SURGERY GROUP PA
Classification: Dentist - 1223S0112X
Entity Type: Organization

Specialization: Oral and Maxillofacial Surgery

CLIA Number: 31D2208954

Address:
920 MAIN ST
HACKENSACK, NJ
ZIP 07601
Phone: (201) 343-8297
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BERGEN ORAL SURGERY GROUP PA is an oral and maxillofacial surgery dentist in Hackensack, NJ. The provider is the specialty of dentistry which includes the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region. BERGEN ORAL SURGERY GROUP PA NPI is 1316024458. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

920 MAIN ST
HACKENSACK, NJ
ZIP 07601-017
Phone: (201) 343-8297
Fax: (201) 343-2535

The provider's authorized official is Steven M Moss .
The authorized official title is President and has the following contact phone number (201) 343-8297.

The CLIA number assigned to this NPI record is 31D2208954 - other practitioner with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 11/1/2006 and was last updated on 6/5/2013.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
11223S0112XDentistOral and Maxillofacial Surgery22DI01524901NEW JERSEYYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1BE159655MEDICARE PINNEW JERSEY

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

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