Provider Demographics
NPI:1235402785
Name:NASSAU DENTAL PC
Entity Type:Organization
Organization Name:NASSAU DENTAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:
Authorized Official - Last Name:PALEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:516-538-8980
Mailing Address - Street 1:91 CLINTON ST
Mailing Address - Street 2:
Mailing Address - City:HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11550-4211
Mailing Address - Country:US
Mailing Address - Phone:516-538-8980
Mailing Address - Fax:516-538-8988
Practice Address - Street 1:91 CLINTON ST
Practice Address - Street 2:
Practice Address - City:HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11550-4211
Practice Address - Country:US
Practice Address - Phone:516-538-8980
Practice Address - Fax:516-538-8988
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-14
Last Update Date:2012-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0281281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY028128Medicaid