1255796553 NPI number — YONKERS ORAL SURGERY, PLLC

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 1255796553 NPI number — YONKERS ORAL SURGERY, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
YONKERS ORAL SURGERY, PLLC
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:
1255796553
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/14/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
73 MARKET STREET
Provider Second Line Business Mailing Address:
SUITE 377
Provider Business Mailing Address City Name:
YONKERS
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10710
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
914-779-5606
Provider Business Mailing Address Fax Number:
914-968-2474

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
73 MARKET STREET
Provider Second Line Business Practice Location Address:
SUITE 377
Provider Business Practice Location Address City Name:
YONKERS
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10710
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
914-779-5606
Provider Business Practice Location Address Fax Number:
914-968-2474
Provider Enumeration Date:
12/31/2015

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)

  • Identifier: 00678024 ETIN AJ19 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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