1629233358 NPI number — MANHATTAN MAXILLOFACIAL SURGERY GROUP

Table of content: BRIAN JOESPH CONROY ATC (NPI 1457521171)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629233358 NPI number — MANHATTAN MAXILLOFACIAL SURGERY GROUP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MANHATTAN MAXILLOFACIAL SURGERY GROUP
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:
Provider Other Organization Name Type Code:
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:
1629233358
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/22/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
45 W 54TH ST
Provider Second Line Business Mailing Address:
SUITE 1E
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10019-5404
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
212-245-5801
Provider Business Mailing Address Fax Number:
212-977-9486

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
45 W 54TH ST
Provider Second Line Business Practice Location Address:
SUITE 1E
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10019-5404
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-245-5801
Provider Business Practice Location Address Fax Number:
212-977-9486
Provider Enumeration Date:
07/22/2008

Additional Information

Authorized Official

Authorized Official Last Name:
DEL VALLE
Authorized Official First Name:
ANTONIO
Authorized Official Middle Name:
L
Authorized Official Title or Position:
ORAL AND MAXILLOFACIAL SURGEON
Authorized Official Telephone Number:
212-245-5801

Provider Taxonomy Codes

  • Taxonomy code: 1223S0112X , with the licence number:  048825-1 , 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)





Copyright © 2007-2025 www.npivalidator.com