1255796553 NPI number — YONKERS ORAL SURGERY, PLLC

Table of content: (NPI 1255796553)

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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