Healthcare Provider Details

I. General information

NPI: 1801404231
Provider Name (Legal Business Name): RIVERSIDE ORAL SURGERY - CHATHAM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2020
Last Update Date: 07/22/2020
Certification Date: 07/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 MAIN ST
CHATHAM NJ
07928-2433
US

IV. Provider business mailing address

130 KINDERKAMACK RD STE 204
RIVER EDGE NJ
07661-1931
US

V. Phone/Fax

Practice location:
  • Phone: 973-635-5800
  • Fax:
Mailing address:
  • Phone: 201-487-6565
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. JASON MICHAEL AUERBACH
Title or Position: OWNER
Credential: DDS
Phone: 917-538-7853