NPIMap

Organization Active NPI

Broadway Oral Surgery, LLC

  • General Practice Dentistry
  • Elizabeth, NJ
National Provider Identifier
1710703541
Registry record updated Nov 26, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
BROADWAY ORAL SURGERY, LLC
Practice address
65 Jefferson Ave
Floor 2 Suite a
Elizabeth, NJ 07201
Phone
(908) 677-5040
NPI assigned
Nov 26, 2024
Last updated
Nov 26, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 26, 2024

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

Authorized official

Name
Mr. Michael Skolnick, DMD
Title
Owner
Phone
(908) 469-9100

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X NU Primary
Pediatric Dentistry 1223P0221X NU
Oral and Maxillofacial Surgery (Dentist) 1223S0112X NU
Orthodontics and Dentofacial Orthopedics Dentistry 1223X0400X NU

Addresses

Primary practice location

65 Jefferson Ave
Floor 2 Suite a
Elizabeth, NJ 07201

Mailing address

65 Jefferson Ave
Floor 2 Suite a
Elizabeth, NJ 07201
Phone (908) 677-5040

National Provider Directory

National Provider Directory
Tax ID family
Broadway Oral Surgery LLC4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1732579200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1732579200000",
    "number": "1710703541",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "65 JEFFERSON AVE",
            "address_2": "FLOOR 2 SUITE A",
            "city": "ELIZABETH",
            "state": "NJ",
            "postal_code": "07201",
            "telephone_number": "908-677-5040"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "65 JEFFERSON AVE",
            "address_2": "FLOOR 2 SUITE A",
            "city": "ELIZABETH",
            "state": "NJ",
            "postal_code": "07201",
            "telephone_number": "908-677-5040"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BROADWAY ORAL SURGERY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-11-26",
        "last_updated": "2024-11-26",
        "status": "A",
        "authorized_official_last_name": "SKOLNICK",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "908-469-9100",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Elizabeth, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 26, 2024; 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.