Healthcare Provider Details

I. General information

NPI: 1043661440
Provider Name (Legal Business Name): MOFS-NJ ORAL FACIAL SURGERY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2016
Last Update Date: 02/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 WASHINGTON ST
HOBOKEN NJ
07030-5105
US

IV. Provider business mailing address

6118 RIVERDALE AVE
BRONX NY
10471-1009
US

V. Phone/Fax

Practice location:
  • Phone: 201-659-1600
  • Fax: 212-202-6447
Mailing address:
  • Phone: 646-360-4840
  • Fax: 212-202-6447

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. JANET BODEY
Title or Position: MANAGEING MEMBER
Credential: DDS
Phone: 646-360-4840