Healthcare Provider Details

I. General information

NPI: 1558037317
Provider Name (Legal Business Name): ORAL SURGERY ASSOCIATES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2021
Last Update Date: 12/10/2021
Certification Date: 12/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

335 LENOX AVE
NEW YORK NY
10027-3703
US

IV. Provider business mailing address

2 LORRAINE DR
PARK RIDGE NJ
07656-1430
US

V. Phone/Fax

Practice location:
  • Phone: 645-585-1515
  • Fax:
Mailing address:
  • Phone: 201-602-2763
  • Fax: 201-391-4316

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: JOHN VINCENT VECCHIONE
Title or Position: CEO
Credential: DDS
Phone: 201-602-2763