SOUTH JERSEY ORAL & MAXILLOFACIAL SURGEONS, LLC (NPI# 1447272562) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1447272562 |
| Entity Type | Organization |
| Organization Name | SOUTH JERSEY ORAL & MAXILLOFACIAL SURGEONS, LLC |
| Practice Address |
135 Jackson Rd Suite A Medford NJ 08055-9231 |
| Practice Telephone | 6096541300 |
| Practice Fax Number | 6096540040 |
| Mailing Telephone | 6096541300 |
| Mailing Fax Number | 6096540040 |
| Enumeration Date | 2006-07-25 |
| Last Update Date | 2008-06-30 |
| Authorized Official Name | DR. AMERIGO FEDELI (DOCTOR) |
| Authorized Official Telephone | 6096541300 |
| Authorized Official Credential | DMD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 1223X0008X |
Dentist Specialization: Oral and Maxillofacial Radiology |
Dental Providers | ||
| Y | 1223S0112X |
Dentist Specialization: Oral and Maxillofacial Surgery |
Dental Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NJ | 7945108 | 05 |
| Street Address |
135 JACKSON RD SUITE A |
| City | MEDFORD |
| State | NJ |
| Zip Code | 08055-9231 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104859974 | Joseph L Matise | Dentist | 135 Jackson Rd, Laurel Professional Center - Suite A, Medford, NJ 08055-9231 | 2006-07-07 |
| 1750449617 | Terri Lee Murphy | Pediatrics | 135 Jackson Rd, Suite B, Medford, NJ 08055-9231 | 2006-12-04 |
| 1922027820 | Amerigo J Fedeli | Dentist | 135 Jackson Rd, Laurel Professional Center - Suite A, Medford, NJ 08055-9231 | 2006-07-19 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215406459 | Natalia Eltabaa | Nurse Practitioner | 143b Atsion Rd, Medford, NJ 08055 | 2018-11-16 |
| 1922574326 | Emily G Wilkins | Psychiatry & Neurology | 239 Taunton, A-2, Medford, NJ 08055 | 2018-10-23 |
| 1508348863 | Gerald D Mingin Jr. | Psychologist | 135 Eayrestown Rd. Suite A, Southampton, NJ 08055 | 2018-09-04 |
| 1316465750 | Gabriella Marie Francis | Specialist/Technologist | 133 Apache Trail, Medford Lakes, NJ 08055 | 2017-09-06 |
| 1265968572 | Bancroft Neurohealth | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 609 Eugenia, Medford, NJ 08055 | 2017-05-05 |
| 1326574690 | Bancroft Neurohealth | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 1503 Cedar Dr, Medford, NJ 08055 | 2017-05-05 |
| 1780110007 | Bancroft Neurohealth | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 1610 Cedar Dr, Medford, NJ 08055 | 2017-05-05 |
| 1902332216 | Bancroft Neurohealth | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 1909 Cedar Dr, Medford, NJ 08055 | 2017-05-05 |
| 1083140396 | Bancroft Neurohealth | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 503 Eugenia Dr, Medford, NJ 08055 | 2017-05-05 |
| 1457887762 | Bancroft Neurohealth | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 905 Eugenia Dr, Medford, NJ 08055 | 2017-05-05 |
| Find all providers in zip 08055 | ||||
| Taxonomy Code | 1223S0112X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Oral and Maxillofacial Surgery |
| The specialty of dentistry which includes the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760665046 | Rajiv Rajagopal | Dentist | 1625 E Mcandrews Rd # A, Medford, OR 97504-5334 | 2007-12-10 |
| 1275608945 | Tony Woo | Dentist | 92 High St., Unit Dh 26, Medford, MA 02155 | 2006-11-21 |
| 1104859974 | Joseph L Matise | Dentist | 135 Jackson Rd, Laurel Professional Center - Suite A, Medford, NJ 08055-9231 | 2006-07-07 |
| 1386634418 | Michael J Doherty | Dentist | 460 Murphy Road, Medford, OR 97504 | 2005-10-28 |
| 1184625980 | Associates for Oral & Maxillofacial Surgery | Dentist | 1625 E Mcandrews Rd, #a, Medford, OR 97504-5334 | 2005-08-03 |
| 1467060293 | Omscor LLC | Dentist | 3162 State St, Medford, OR 97504-8450 | 2020-07-17 |
| 1639514672 | Matthew E Myers | Dentist | 3162 State St, Medford, OR 97504 | 2013-05-03 |
| 1588986525 | Oral and Maxillofacial Surgery | Dentist | 3162 State St, Medford, OR 97504-8450 | 2010-02-18 |
| 1205019585 | James D Savage | Dentist | 1625 E Mcandrews Rd # A, Medford, OR 97504-5334 | 2007-12-10 |
| 1841473121 | Bruce S Logan | Dentist | 3162 State St, Medford, OR 97504-8450 | 2007-12-10 |
| Find all providers in MEDFORD | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.