1225220247 NPI number — LONG ISLAND ORAL SURGERY ASSOCIATES, PC.

Table of content: (NPI 1225220247)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225220247 NPI number — LONG ISLAND ORAL SURGERY ASSOCIATES, PC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LONG ISLAND ORAL SURGERY ASSOCIATES, PC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
LONG ISLAND CENTER FOR ORAL AND MAXILLOFACIAL SURGERY
Provider Other Organization Name Type Code:
4
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1225220247
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/17/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
175 JERICHO TPKE
Provider Second Line Business Mailing Address:
SUITE 305
Provider Business Mailing Address City Name:
SYOSSET
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11791-4532
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-921-2880
Provider Business Mailing Address Fax Number:
516-921-2889

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
959 BRUSH HOLLOW RD
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
WESTBURY
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11590-1778
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-333-5900
Provider Business Practice Location Address Fax Number:
516-333-5868
Provider Enumeration Date:
08/14/2007

Additional Information

Authorized Official

Authorized Official Last Name:
GOLDBERG
Authorized Official First Name:
JEFFREY
Authorized Official Middle Name:
Authorized Official Title or Position:
PRES
Authorized Official Telephone Number:
516-333-5900

Provider Taxonomy Codes

  • Taxonomy code: 204E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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