Provider Demographics
NPI:1063444156
Name:MCGOWAN, NEIL RICHARD (DMD)
Entity Type:Individual
Prefix:DR
First Name:NEIL
Middle Name:RICHARD
Last Name:MCGOWAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:30 NEWBRIDGE RD STE 204
Mailing Address - Street 2:
Mailing Address - City:EAST MEADOW
Mailing Address - State:NY
Mailing Address - Zip Code:11554-2150
Mailing Address - Country:US
Mailing Address - Phone:516-520-8688
Mailing Address - Fax:516-520-8676
Practice Address - Street 1:30 NEWBRIDGE RD STE 204
Practice Address - Street 2:
Practice Address - City:EAST MEADOW
Practice Address - State:NY
Practice Address - Zip Code:11554-2150
Practice Address - Country:US
Practice Address - Phone:516-520-8688
Practice Address - Fax:516-520-8676
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2007-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0341771223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00746052Medicaid
NYD2E011Medicare Oscar/Certification
NY00746052Medicaid