Provider Demographics
NPI:1275066748
Name:MIDTOWN ORAL AND MAXILLOFACIAL PATHOLOGY
Entity Type:Organization
Organization Name:MIDTOWN ORAL AND MAXILLOFACIAL PATHOLOGY
Other - Org Name:MIDTOWN ORAL AND MAXILLOFACIAL PATHOLOGY PLLC
Other - Org Type:Other Name
Authorized Official - Title/Position:ORAL AND MAXILLOFACIAL PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:AARON
Authorized Official - Middle Name:
Authorized Official - Last Name:YANCOSKIE
Authorized Official - Suffix:I
Authorized Official - Credentials:DDS
Authorized Official - Phone:917-797-1601
Mailing Address - Street 1:535 W 52ND ST
Mailing Address - Street 2:810
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-7629
Mailing Address - Country:US
Mailing Address - Phone:917-601-7917
Mailing Address - Fax:
Practice Address - Street 1:535 W 52ND ST
Practice Address - Street 2:810
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-7629
Practice Address - Country:US
Practice Address - Phone:917-601-7917
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-11
Last Update Date:2017-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY058235261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
1295094670OtherNPI