Healthcare Provider Details

I. General information

NPI: 1962942771
Provider Name (Legal Business Name): AMERICAN MANAGEMENT GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2017
Last Update Date: 02/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3900 CITY AVENUE APT W1101
PHILADELPHIA PA
19131
US

IV. Provider business mailing address

3900 CITY AVE APT W1101
PHILADELPHIA PA
19131-2963
US

V. Phone/Fax

Practice location:
  • Phone: 973-809-5507
  • Fax:
Mailing address:
  • Phone: 973-809-5507
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDS041050
License Number StatePA

VIII. Authorized Official

Name: MISS JEANETTE Z ROBINSON
Title or Position: ORAL SURGEON
Credential:
Phone: 973-809-5507