NPIMap

Organization Active NPI

Northeast Facial and Oral Surgery Specialists, LLC

  • Oral and Maxillofacial Surgery (Dentist)
  • Florham Park, NJ
National Provider Identifier
1831618529
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X
License
22DI02252800 Issued in NJ
Legal business name
NORTHEAST FACIAL AND ORAL SURGERY SPECIALISTS, LLC
Practice address
83 Hanover Rd Ste 240
Florham Park, NJ 07932-1508
Phone
(973) 360-1100
Fax
(973) 360-1101
NPI assigned
Sep 13, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
Dr. Gregg A Jacob, DMD
Title
Owner
Phone
(973) 360-1100

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Oral and Maxillofacial Surgery (Dentist)Group: 193400000X SINGLE SPECIALTY GROUP 1223S0112X 22DI02252800 NJ Primary

Addresses

Primary practice location

83 Hanover Rd Ste 240
Florham Park, NJ 07932-1508

Mailing address

83 Hanover Rd Ste 240
Florham Park, NJ 07932-1508
Phone (973) 360-1100

National Provider Directory

National Provider Directory

Locations

83 Hanover Rd
Ste 240
Florham Park, NJ 07932
Phone (973) 360-1100

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1505260800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1831618529",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "83 HANOVER RD STE 240",
            "city": "FLORHAM PARK",
            "state": "NJ",
            "postal_code": "079321508",
            "telephone_number": "973-360-1100",
            "fax_number": "973-360-1101"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "83 HANOVER RD STE 240",
            "city": "FLORHAM PARK",
            "state": "NJ",
            "postal_code": "079321508",
            "telephone_number": "973-360-1100",
            "fax_number": "973-360-1101"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHEAST FACIAL AND ORAL SURGERY SPECIALISTS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-09-13",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "JACOB",
        "authorized_official_first_name": "GREGG",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "973-360-1100",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "NJ",
            "license": "22DI02252800",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Florham Park, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.