# NORTHEAST FACIAL AND ORAL SURGERY SPECIALISTS, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1831618529
- **Authorized official:** DR. GREGG A JACOB DMD (OWNER)
- **Authorized official phone:** (973) 360-1100

## Contact information

- **Practice address:** 83 HANOVER RD STE 240, FLORHAM PARK, NJ 07932-1508
- **Practice address phone:** (973) 360-1100
- **Practice address fax:** (973) 360-1101
- **Mailing address:** 83 HANOVER RD STE 240, FLORHAM PARK, NJ 07932-1508
- **Mailing address phone:** (973) 360-1100
- **Mailing address fax:** (973) 360-1101

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | 22DI02252800 | NJ | Yes |

## Other

- **Enumeration date:** 09/13/2017
- **Last updated:** 07/21/2022