Mofs-CT Oral Facial Surgery LLC

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

9973 Issued in CT

Legal business name

MOFS-CT ORAL FACIAL SURGERY LLC

Practice address

1 Boulder Ave
Old Greenwich, CT 06870-1420

Phone

(203) 990-3300

Fax

(212) 202-6447

NPI assigned

Jun 1, 2017

Organization subpart

No

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

Authorized official

Name

Dr. Janet C Bodey, DDSNPI 1568504538

Title

Managing Member

Phone

(203) 998-7470

Specialties & licenses 1

Addresses

Other names 1

• Dental Oral Surgery Doing business as

Medicare fee-for-service enrollment

Enrolled in CT

Enrollment records 1

Locations

Practitioners 1

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

• Janet C Bodey, D.D.S.

  • Oral and Maxillofacial Surgery (Dentist)
  • New York, NY
  • NPI 1568504538

  CT

  Medicare reassignment Authorized official

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

{
    "created_epoch": "1496275200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1496275200000",
    "number": "1861920068",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6118 RIVERDALE AVE",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104711009",
            "telephone_number": "203-998-7470",
            "fax_number": "212-202-6447"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 BOULDER AVE",
            "city": "OLD GREENWICH",
            "state": "CT",
            "postal_code": "068701420",
            "telephone_number": "203-990-3300",
            "fax_number": "212-202-6447"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOFS-CT ORAL FACIAL SURGERY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-06-01",
        "last_updated": "2017-06-01",
        "status": "A",
        "authorized_official_last_name": "BODEY",
        "authorized_official_first_name": "JANET",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "203-998-7470",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "CT",
            "license": "9973",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dental Oral Surgery",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Ranya K Marjieh
• Mary Elizabeth Karlan
• Jamie McRoberts Griffin, PT
• Jake Metsky
• Jennifer Sarah Millman, MD
• Judith Mosesso
• Memphis Mackenzie Moye
• Aimee Muth, LCSW
• Crystal Nelson, CLC
• Katherine Gail Nelson, OTR/L

• Oral and Maxillofacial Surgery (Dentist) in Old Greenwich, CT
• Providers in Old Greenwich, CT by specialty
• Oral and Maxillofacial Surgery (Dentist) in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 1, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.