1710996038 NPI number — PLAINVIEW ORAL & MAXILLOFACIAL ASSOCIATES, P.C.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710996038 NPI number — PLAINVIEW ORAL & MAXILLOFACIAL ASSOCIATES, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PLAINVIEW ORAL & MAXILLOFACIAL ASSOCIATES, P.C.
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:
1710996038
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1181 OLD COUNTRY RD
Provider Second Line Business Mailing Address:
SUITE 4
Provider Business Mailing Address City Name:
PLAINVIEW
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11803-5018
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-822-7880
Provider Business Mailing Address Fax Number:
516-822-5010

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1181 OLD COUNTRY RD
Provider Second Line Business Practice Location Address:
SUITE 4
Provider Business Practice Location Address City Name:
PLAINVIEW
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11803-5018
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-822-7880
Provider Business Practice Location Address Fax Number:
516-822-5010
Provider Enumeration Date:
08/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BASS
Authorized Official First Name:
BARRY
Authorized Official Middle Name:
DAVID
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
516-822-7880

Provider Taxonomy Codes

  • Taxonomy code: 1223S0112X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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