Provider Demographics
NPI:1093049934
Name:ORAL MAXILOFACIAL AND DENTAL PAIN MANAGMENT
Entity Type:Organization
Organization Name:ORAL MAXILOFACIAL AND DENTAL PAIN MANAGMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BASSIUR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:516-374-2266
Mailing Address - Street 1:PO BOX 387
Mailing Address - Street 2:
Mailing Address - City:WOODMERE
Mailing Address - State:NY
Mailing Address - Zip Code:11598-0387
Mailing Address - Country:US
Mailing Address - Phone:516-374-2266
Mailing Address - Fax:516-374-8999
Practice Address - Street 1:18 E 50TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-6817
Practice Address - Country:US
Practice Address - Phone:516-374-2266
Practice Address - Fax:516-374-8999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-24
Last Update Date:2009-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027392-A261QP3300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain