Provider Demographics
NPI:1154734325
Name:HELLER ORAL SUGERY LLC
Entity type:Organization
Organization Name:HELLER ORAL SUGERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FARIBA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHARIFAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:973-481-3078
Mailing Address - Street 1:639 MOUNT PROSPECT AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07104-3109
Mailing Address - Country:US
Mailing Address - Phone:973-481-3078
Mailing Address - Fax:973-481-2999
Practice Address - Street 1:639 MOUNT PROSPECT AVE FL 2
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07104-3109
Practice Address - Country:US
Practice Address - Phone:973-481-3078
Practice Address - Fax:973-481-2999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-05
Last Update Date:2014-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ240581223P0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0106XDental ProvidersDentistOral and Maxillofacial PathologyGroup - Multi-Specialty