Provider Demographics
NPI:1245251172
Name:MADISON AVENUE ORAL & MAXILLOFACIAL SURGERY ASSOCIATES, LLC
Entity type:Organization
Organization Name:MADISON AVENUE ORAL & MAXILLOFACIAL SURGERY ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:P
Authorized Official - Last Name:PRESS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:973-984-7000
Mailing Address - Street 1:95 MADISON AVE
Mailing Address - Street 2:SUITE 108
Mailing Address - City:MORRISTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07960-6092
Mailing Address - Country:US
Mailing Address - Phone:973-984-7000
Mailing Address - Fax:973-984-0051
Practice Address - Street 1:95 MADISON AVE
Practice Address - Street 2:SUITE 108
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960-6092
Practice Address - Country:US
Practice Address - Phone:973-984-7000
Practice Address - Fax:973-984-0051
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-23
Last Update Date:2015-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty