Provider Demographics
NPI:1487810974
Name:AOCOM SURGERY LLC
Entity type:Organization
Organization Name:AOCOM SURGERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:VERGOS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD,MD
Authorized Official - Phone:732-920-8800
Mailing Address - Street 1:35 BEAVERSON BLVD.
Mailing Address - Street 2:SUITE 10A LIONS HEAD OFFICE PARK
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08723
Mailing Address - Country:US
Mailing Address - Phone:732-920-8800
Mailing Address - Fax:732-920-8861
Practice Address - Street 1:35 BEAVERSON BLVD
Practice Address - Street 2:SUITE 10A LIONS HEAD OFFICE PARK
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08723-7812
Practice Address - Country:US
Practice Address - Phone:732-920-8800
Practice Address - Fax:732-920-8861
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-04
Last Update Date:2008-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI137151223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJU10479Medicare UPIN