Healthcare Provider Details

I. General information

NPI: 1023320058
Provider Name (Legal Business Name): HOBOKEN ORAL SURGERY GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2010
Last Update Date: 07/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 E BROAD ST SUITE #3
WESTFIELD NJ
07090-2190
US

IV. Provider business mailing address

505 E BROAD ST SUITE #3
WESTFIELD NJ
07090-2190
US

V. Phone/Fax

Practice location:
  • Phone: 908-789-8811
  • Fax: 908-789-1729
Mailing address:
  • Phone: 908-789-8811
  • Fax: 908-789-1729

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDI16993
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDI02425000
License Number StateNJ
# 3
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDI19578
License Number StateNJ

VIII. Authorized Official

Name: DR. HUGO QUINONES
Title or Position: OWNER
Credential: DMD
Phone: 908-789-8811