MEDICARE: HOBOKEN ORAL SURGERY GROUP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	1699303	NJ

General Provider Information

NPI Number	:	1457650418
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOBOKEN ORAL SURGERY GROUP

Provider Business Mailing Address
First Line	:	231 WASHINGTON ST
Second Line	:	2ND FLOOR
City	:	HOBOKEN
State	:	NJ
Zip	:	07030-4738
Country	:	US
Telephone Number	:	201-418-7300
Fax Number	:	201-418-0102

Provider Business Practice Location Address
First Line	:	231 WASHINGTON ST
Second Line	:	2ND FLOOR
City	:	HOBOKEN
State	:	NJ
Zip	:	07030-4738
Country	:	US
Telephone Number	:	201-418-7300
Fax Number	:	201-418-0102

Authorized Official
Title or Position	:	ORAL SURGEON/ OWNER
Name	:	DR. IGNATIUS SCALIA
Credential	:	D.M.D.
Telephone Number	:	201-418-7300

Provider Enumeration Date	:	03/16/2011
Last Update Date	:	03/16/2011

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