Healthcare Provider Details

I. General information

NPI: 1083687149
Provider Name (Legal Business Name): ORAL SURGERY GROUP, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 LIVINGSTON AVE
NEW BRUNSWICK NJ
08901-2410
US

IV. Provider business mailing address

109 LIVINGSTON AVE
NEW BRUNSWICK NJ
08901-2410
US

V. Phone/Fax

Practice location:
  • Phone: 732-247-8083
  • Fax: 732-247-1584
Mailing address:
  • Phone: 732-247-8083
  • Fax: 732-247-1584

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. PHILIP S. ENGEL
Title or Position: DOCTOR
Credential: DMD
Phone: 732-247-8083