MEDICARE: FREDA & SURIANO ORTHODONTICS

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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry

General Provider Information

NPI Number	:	1861609786
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FREDA & SURIANO ORTHODONTICS

Provider Business Mailing Address
First Line	:	122 MORRISTOWN RD
Second Line	:
City	:	BERNARDSVILLE
State	:	NJ
Zip	:	07924-2339
Country	:	US
Telephone Number	:	908-295-5343
Fax Number	:	908-766-1087

Provider Business Practice Location Address
First Line	:	557 BROAD ST
Second Line	:
City	:	BLOOMFIELD
State	:	NJ
Zip	:	07003-2885
Country	:	US
Telephone Number	:	973-748-2248
Fax Number	:	973-748-7004

Authorized Official
Title or Position	:	CO-OWNER
Name	:	DR. ANTHONY THOMAS SURIANO
Credential	:	D.M.D.
Telephone Number	:	973-748-2248

Provider Enumeration Date	:	05/17/2007
Last Update Date	:	04/23/2008

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