Healthcare Provider Details

I. General information

NPI: 1902582711
Provider Name (Legal Business Name): JERSEY CITY ORAL SURGERY & DENTAL IMPLANT CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2023
Last Update Date: 06/26/2023
Certification Date: 06/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 NEWARK AVE STE 500
JERSEY CITY NJ
07302-5873
US

IV. Provider business mailing address

17 AVE AT PORT IMPERIAL UNIT 1016
WEST NEW YORK NJ
07093
US

V. Phone/Fax

Practice location:
  • Phone: 201-565-0409
  • Fax:
Mailing address:
  • Phone: 508-208-2943
  • 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. MATTHEW MOY
Title or Position: OWNER
Credential: DDS, MD
Phone: 508-208-2943