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General NPI Number Information
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NPI Number | 1841004454
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Entity Type | Organization
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Legal Business Name | NORTHEAST ORAL AND MAXILLOFACIAL SURGERY
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Dates
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Enumeration Date | 02/04/2025
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Last Update Date | 02/04/2025
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Provider Practice Location Address
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Address Line | 310 PASSAIC AVE STE 203
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City | FAIRFIELD
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State | NJ
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Zip | 07004-2523
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Country | US
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Telephone | 973-256-0103
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Fax |
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Provider Business Mailing Address
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Address Line | 310 PASSAIC AVE STE 203
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City | FAIRFIELD
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State | NJ
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Zip | 07004-2523
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Country | US
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Telephone | 973-256-0103
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Fax |
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Authorized Official
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Title or Position | ORAL SURGEON
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Name | MARIANNE CIFELLI
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Credential | DMD
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Telephone | 973-256-0103
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number |
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License Number State |
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