201 Oral Surgery

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

22DI02332400 Issued in NJ

Legal business name

201 ORAL SURGERY

Practice address

180 Old Tappan Rd
Old Tappan, NJ 07675-7052

Phone

(201) 767-4001

NPI assigned

Sep 28, 2011

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Suzanne Waltke

Title

Office Manager

Phone

(201) 767-4001

Specialties & licenses 3

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1317168000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1317168000000",
    "number": "1073896809",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "180 OLD TAPPAN RD",
            "city": "OLD TAPPAN",
            "state": "NJ",
            "postal_code": "076757052"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "180 OLD TAPPAN RD",
            "city": "OLD TAPPAN",
            "state": "NJ",
            "postal_code": "076757052",
            "telephone_number": "201-767-4001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "201 ORAL SURGERY",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-09-28",
        "last_updated": "2011-09-28",
        "status": "A",
        "authorized_official_last_name": "WALTKE",
        "authorized_official_first_name": "SUZANNE",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "201-767-4001",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "NJ",
            "license": "22DI01547211",
            "primary": false
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "NJ",
            "license": "22DI02332400",
            "primary": true
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "NJ",
            "license": "22DI01805400",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Oral and Maxillofacial Surgery (Dentist) in Old Tappan, NJ
• Providers in Old Tappan, NJ by specialty
• Oral and Maxillofacial Surgery (Dentist) in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.