1447086608 NPI number — APEX ORAL SURGERY, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447086608 NPI number — APEX ORAL SURGERY, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
APEX ORAL SURGERY, LLC
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:
1447086608
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/12/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
600 HUDSON ST APT 6E
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOBOKEN
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07030-5925
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
908-514-5126
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
210 MAIN ST STE 2A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MADISON
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07940-2285
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-210-7076
Provider Business Practice Location Address Fax Number:
973-210-7071
Provider Enumeration Date:
09/12/2024

Additional Information

Authorized Official

Authorized Official Last Name:
CAPPETTA
Authorized Official First Name:
EMIL
Authorized Official Middle Name:
JOHN ARMAND
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
908-514-5126

Provider Taxonomy Codes

  • Taxonomy code: 204E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0451099714 . This is a "TAX ID NUMBER" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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