Provider Demographics
NPI:1528702891
Name:RARITAN BAY ORAL SURGERY
Entity type:Organization
Organization Name:RARITAN BAY ORAL SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORAL SURGERON/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:FLUGRAD
Authorized Official - Suffix:SR
Authorized Official - Credentials:DMD
Authorized Official - Phone:732-442-1860
Mailing Address - Street 1:453 AMBOY AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07095-2949
Mailing Address - Country:US
Mailing Address - Phone:732-442-1860
Mailing Address - Fax:732-874-5198
Practice Address - Street 1:453 AMBOY AVE STE 2
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07095-2949
Practice Address - Country:US
Practice Address - Phone:732-442-1860
Practice Address - Fax:732-874-5198
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:45-3358409
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-04-23
Last Update Date:2022-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0285391Medicaid
NJ1873407Medicaid
NJ1598745531Medicaid