Healthcare Provider Details

I. General information

NPI: 1194846014
Provider Name (Legal Business Name): ASSOCIATES IN ORAL & MAXILLOFACIAL SURGERY, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

475 MORRIS AVE
SPRINGFIELD NJ
07081-1005
US

IV. Provider business mailing address

475 MORRIS AVE
SPRINGFIELD NJ
07081-1005
US

V. Phone/Fax

Practice location:
  • Phone: 973-376-1144
  • Fax:
Mailing address:
  • Phone: 973-376-1144
  • 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. DAVID L. EIDELMAN
Title or Position: OWNER
Credential: D.D.S
Phone: 973-376-1144