Surgery Center of Penthouse IV

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

Legal business name

SURGERY CENTER OF PENTHOUSE IV

Practice address

101 Old Short Hills Road
West Orange, NJ 07052

Phone

(973) 736-1345

Fax

(973) 325-3487

NPI assigned

Oct 24, 2006

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Theodore A Niebloom, DMDNPI 1689750705

Title

Doctor Administrative Director

Phone

(973) 736-7616

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Theodore A Niebloom, DMD

  • Oral and Maxillofacial Surgery (Dentist)
  • West Orange, NJ
  • NPI 1689750705
  Authorized official Same address or phone

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

{
    "created_epoch": "1161648000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1710060496",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 OLD SHORT HILLS ROAD",
            "city": "WEST ORANGE",
            "state": "NJ",
            "postal_code": "07052",
            "telephone_number": "973-736-1345",
            "fax_number": "973-325-3487"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 OLD SHORT HILLS ROAD",
            "city": "WEST ORANGE",
            "state": "NJ",
            "postal_code": "07052",
            "telephone_number": "973-736-1345",
            "fax_number": "973-325-3487"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SURGERY CENTER OF PENTHOUSE IV",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-24",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "NIEBLOOM",
        "authorized_official_first_name": "THEODORE",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "DOCTOR ADMINISTRATIVE DIRECTOR",
        "authorized_official_telephone_number": "973-736-7616",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Summit Ridge Care LLC
• Samuel Sun, MD
• Supportive Therapeutic Services, LLC
• Supreme Dental Associates, LLC
• Surg-Elite PC
• Surgical and Professional Services PC
• Robyn Lisa Sutton, DPT
• Priscilla Swalm
• Amanda Jaclyn Sylvester, PT, DPT
• Claudine M. Sylvester, M. D.

• Oral and Maxillofacial Surgery (Dentist) in West Orange, NJ
• Providers in West Orange, 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 Aug 22, 2020; 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.