1689667149 NPI number — WESTWOOD ORAL SURGERY ASSOCIATES PA

Table of content: (NPI 1689667149)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689667149 NPI number — WESTWOOD ORAL SURGERY ASSOCIATES PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WESTWOOD ORAL SURGERY ASSOCIATES PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1689667149
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/30/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
992 MANTUA PIKE
Provider Second Line Business Mailing Address:
SUITE 302
Provider Business Mailing Address City Name:
WOODBURY HEIGHTS
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08097-1246
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
856-845-1341
Provider Business Mailing Address Fax Number:
856-384-9067

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
992 MANTUA PIKE
Provider Second Line Business Practice Location Address:
SUITE 302
Provider Business Practice Location Address City Name:
WOODBURY HEIGHTS
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08097-1246
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-845-1341
Provider Business Practice Location Address Fax Number:
856-384-9067
Provider Enumeration Date:
08/30/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SEEGER
Authorized Official First Name:
DOUGLAS
Authorized Official Middle Name:
H
Authorized Official Title or Position:
ORAL SURGEON
Authorized Official Telephone Number:
856-845-1341

Provider Taxonomy Codes

  • Taxonomy code: 1223S0112X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 17706 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: CN0708 . This is a "GROUP PTAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 008536900 . This is a "AMERIHEALTH MANAGED CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0085369001 . This is a "MHS LEGACY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 159702 . This is a "AMERIHEALTH PPO" identifier . This identifiers is of the category "OTHER".