Healthcare Provider Details

I. General information

NPI: 1710817689
Provider Name (Legal Business Name): JMO SURGICAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2026
Last Update Date: 05/21/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 WILLOW AVE APT 2C
HOBOKEN NJ
07030-3609
US

IV. Provider business mailing address

130 WILLOW AVE APT 2C
HOBOKEN NJ
07030-3609
US

V. Phone/Fax

Practice location:
  • Phone: 203-598-8052
  • Fax:
Mailing address:
  • Phone: 203-598-8052
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. JEFFREY MICHAEL O'BRIEN
Title or Position: MANAGING MEMBER
Credential: MD
Phone: 203-598-8052