1699782219 NPI number — NEW YORK COMPREHENSIVE ORTHOGNATHIC AND MAXILLOFACIAL SURGERY PC

Table of content: (NPI 1699782219)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699782219 NPI number — NEW YORK COMPREHENSIVE ORTHOGNATHIC AND MAXILLOFACIAL SURGERY PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEW YORK COMPREHENSIVE ORTHOGNATHIC AND MAXILLOFACIAL SURGERY 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:
NEW YORK CENTER FOR ORTHOGNATHIC AND MAXILLOFACIAL SURGERY
Provider Other Organization Name Type Code:
5
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:
1699782219
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/22/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2001 MARCUS AVE
Provider Second Line Business Mailing Address:
SUITE N-10
Provider Business Mailing Address City Name:
NEW HYDE PARK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11042-1011
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-775-1818
Provider Business Mailing Address Fax Number:
516-775-0892

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2001 MARCUS AVE
Provider Second Line Business Practice Location Address:
SUITE N-10
Provider Business Practice Location Address City Name:
NEW HYDE PARK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11042-1011
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-775-1818
Provider Business Practice Location Address Fax Number:
516-775-0892
Provider Enumeration Date:
08/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MAJEED
Authorized Official First Name:
BIBI
Authorized Official Middle Name:
Authorized Official Title or Position:
PATIENT ACCOUNTS
Authorized Official Telephone Number:
516-775-1818

Provider Taxonomy Codes

  • Taxonomy code: 204E00000X , with the licence number:  024890 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 01145546 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 01559719 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 02212444 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 02238062 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 01335919 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00501157 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 01463525 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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