Healthcare Provider Details

I. General information

NPI: 1275767535
Provider Name (Legal Business Name): ESSEX ORAL SUGERY ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2009
Last Update Date: 05/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

364 FRANKLIN ST
BLOOMFIELD NJ
07003-3446
US

IV. Provider business mailing address

364 FRANKLIN ST
BLOOMFIELD NJ
07003-3446
US

V. Phone/Fax

Practice location:
  • Phone: 973-748-1515
  • Fax: 973-748-5216
Mailing address:
  • Phone: 973-748-1515
  • Fax: 973-748-5216

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number22DI01329800
License Number StateNJ

VIII. Authorized Official

Name: DR. STEVEN ARTHUR LILIEN
Title or Position: ORAL SURGEON
Credential: D.D.S.
Phone: 973-748-1515