Provider Demographics
NPI:1154653327
Name:RAMAPO ORAL & MAXILLOFACIAL SURGERY
Entity type:Organization
Organization Name:RAMAPO ORAL & MAXILLOFACIAL SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANUP
Authorized Official - Middle Name:
Authorized Official - Last Name:MUDULI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:201-337-3797
Mailing Address - Street 1:180 RAMAPO VALLEY RD
Mailing Address - Street 2:ROUTE 202
Mailing Address - City:OAKLAND
Mailing Address - State:NJ
Mailing Address - Zip Code:07436-2500
Mailing Address - Country:US
Mailing Address - Phone:201-337-3797
Mailing Address - Fax:201-337-8845
Practice Address - Street 1:180 RAMAPO VALLEY RD
Practice Address - Street 2:ROUTE 202
Practice Address - City:OAKLAND
Practice Address - State:NJ
Practice Address - Zip Code:07436-2500
Practice Address - Country:US
Practice Address - Phone:201-337-3797
Practice Address - Fax:201-337-8845
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-12
Last Update Date:2010-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial SurgeryGroup - Single Specialty