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General NPI Number Information
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NPI Number | 1629792551
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Entity Type | Organization
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Legal Business Name | N.J. ORAL & FACIAL SURGERY OF MONROE, LLC
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Dates
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Enumeration Date | 10/04/2022
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Last Update Date | 10/04/2022
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Provider Practice Location Address
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Address Line | 18 CENTRE DR STE 202
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City | MONROE
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State | NJ
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Zip | 08831-1501
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Country | US
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Telephone | 609-395-8300
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Fax |
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Provider Business Mailing Address
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Address Line | 12 WHITNEY DR
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City | MARLBORO
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State | NJ
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Zip | 07746-1242
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Country | US
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Telephone | 646-651-6499
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. NIKOLAY LEVINTOV
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Credential | MD, DDS
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Telephone | 609-395-8300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 204E00000X
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Taxonomy Name | Oral & Maxillofacial Surgery (D.M.D.)
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License Number |
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License Number State |
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