| Bergen Oral Surgery Group Pa | |
|
920 Main St Hackensack NJ 07601-5017 | |
| (201) 343-8297 | |
| (201) 343-2535 |
| Full Name | Bergen Oral Surgery Group Pa |
|---|---|
| Speciality | Dentist |
| Location | 920 Main St, Hackensack, New Jersey |
| Authorized Official Name and Position | Steven M Moss (PRESIDENT) |
| Authorized Official Contact | 2013438297 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Bergen Oral Surgery Group Pa 920 Main St Hackensack NJ 07601-5017 Ph: (201) 343-8297 | Bergen Oral Surgery Group Pa 920 Main St Hackensack NJ 07601-5017 Ph: (201) 343-8297 |
| NPI Number | 1316024458 |
|---|---|
| Provider Enumeration Date | 11/01/2006 |
| Last Update Date | 06/05/2013 |
| Medicare PECOS PAC ID | 9739283763 |
|---|---|
| Medicare Enrollment ID | O20070402000351 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1316024458 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | 22DI01524901 (New Jersey) | Primary |
| Provider Name | Jason Gordon |
|---|---|
| Provider Type | Practitioner - Maxillofacial Surgery |
| Provider Identifiers | NPI Number: 1033641493 PECOS PAC ID: 8426451626 Enrollment ID: I20210726002925 |
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