1790149235 NPI number — NEW ROCHELLE ORAL SURGERY

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 1790149235 NPI number — NEW ROCHELLE ORAL SURGERY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEW ROCHELLE ORAL SURGERY
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:
1790149235
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/11/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
77 QUAKER RIDGE RD
Provider Second Line Business Mailing Address:
SUITE 212
Provider Business Mailing Address City Name:
NEW ROCHELLE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10804-2808
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
914-235-1235
Provider Business Mailing Address Fax Number:
914-235-0794

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
77 QUAKER RIDGE RD
Provider Second Line Business Practice Location Address:
SUITE 212
Provider Business Practice Location Address City Name:
NEW ROCHELLE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10804-2808
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
914-235-1235
Provider Business Practice Location Address Fax Number:
914-235-0794
Provider Enumeration Date:
04/11/2016

Additional Information

Authorized Official

Authorized Official Last Name:
PEREZ
Authorized Official First Name:
HELEN
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
ASSISTANT OFFICE MANAGER
Authorized Official Telephone Number:
914-472-5252

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)





Copyright © 2007-2026 www.npivalidator.com