Provider Demographics
NPI:1437215563
Name:GURMAN, MYRON (DDS)
Entity Type:Individual
Prefix:DR
First Name:MYRON
Middle Name:
Last Name:GURMAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 BRIDLE PATH
Mailing Address - Street 2:
Mailing Address - City:ROSLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11576-3115
Mailing Address - Country:US
Mailing Address - Phone:516-742-7751
Mailing Address - Fax:516-742-7751
Practice Address - Street 1:5231 LITTLE NECK PKWY
Practice Address - Street 2:
Practice Address - City:LITTLE NECK
Practice Address - State:NY
Practice Address - Zip Code:11362-1836
Practice Address - Country:US
Practice Address - Phone:718-224-0040
Practice Address - Fax:718-224-8853
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024006-11223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00319397Medicaid
NYT49276Medicare UPIN