Provider Demographics
NPI:1366638397
Name:PROTZEL ORAL & MAXILLOFACIAL SURGERY, LLP
Entity Type:Organization
Organization Name:PROTZEL ORAL & MAXILLOFACIAL SURGERY, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:E
Authorized Official - Last Name:PROTZEL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MD
Authorized Official - Phone:516-735-6505
Mailing Address - Street 1:4277 HEMPSTEAD TPKE
Mailing Address - Street 2:SUITE 214
Mailing Address - City:BETHPAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11714-5709
Mailing Address - Country:US
Mailing Address - Phone:516-735-6505
Mailing Address - Fax:516-735-3326
Practice Address - Street 1:4277 HEMPSTEAD TPKE
Practice Address - Street 2:SUITE 214
Practice Address - City:BETHPAGE
Practice Address - State:NY
Practice Address - Zip Code:11714-5709
Practice Address - Country:US
Practice Address - Phone:516-735-6505
Practice Address - Fax:516-735-3326
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-24
Last Update Date:2009-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0471681223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYD44211Medicare UPIN
NYDE5041Medicare UPIN
NYD9W221Medicare PIN