Healthcare Provider Details

I. General information

NPI: 1457650418
Provider Name (Legal Business Name): HOBOKEN ORAL SURGERY GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2011
Last Update Date: 03/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

231 WASHINGTON ST 2ND FLOOR
HOBOKEN NJ
07030-4738
US

IV. Provider business mailing address

231 WASHINGTON ST 2ND FLOOR
HOBOKEN NJ
07030-4738
US

V. Phone/Fax

Practice location:
  • Phone: 201-418-7300
  • Fax: 201-418-0102
Mailing address:
  • Phone: 201-418-7300
  • Fax: 201-418-0102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number1699303
License Number StateNJ

VIII. Authorized Official

Name: DR. IGNATIUS SCALIA
Title or Position: ORAL SURGEON/ OWNER
Credential: D.M.D.
Phone: 201-418-7300