1912048844 NPI number — NEW YORK MAXILLOFACIAL SURGERY, 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 1912048844 NPI number — NEW YORK MAXILLOFACIAL SURGERY, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEW YORK MAXILLOFACIAL SURGERY, 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:
1912048844
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/01/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
110 E 55TH ST
Provider Second Line Business Mailing Address:
15TH FLOOR
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10022-4540
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
212-308-9200
Provider Business Mailing Address Fax Number:
212-308-9212

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
110 E 55TH ST
Provider Second Line Business Practice Location Address:
15TH FLOOR
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10022-4540
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-308-9200
Provider Business Practice Location Address Fax Number:
212-308-9212
Provider Enumeration Date:
02/12/2007

Additional Information

Authorized Official

Authorized Official Last Name:
NEUGARTEN
Authorized Official First Name:
JAY
Authorized Official Middle Name:
Authorized Official Title or Position:
ORAL SURGEON
Authorized Official Telephone Number:
212-308-9200

Provider Taxonomy Codes

  • Taxonomy code: 204E00000X , with the licence number:  218337 , 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: 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: 02238062 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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