Healthcare Provider Details

I. General information

NPI: 1356626139
Provider Name (Legal Business Name): UNION CITY OMS GROUP, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2011
Last Update Date: 10/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 33RD ST
UNION CITY NJ
07087-4701
US

IV. Provider business mailing address

311 33RD ST
UNION CITY NJ
07087-4701
US

V. Phone/Fax

Practice location:
  • Phone: 201-601-9262
  • Fax: 201-601-2543
Mailing address:
  • Phone: 201-601-9262
  • Fax: 201-601-2543

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDI01888113
License Number StateNJ

VIII. Authorized Official

Name: MRS. NANCY HERBST
Title or Position: ORAL SURGEON
Credential: D.D.S.
Phone: 201-601-9262