Provider Demographics
NPI:1528201613
Name:MANHATTAN ORAL FACIAL SURGERY LLC
Entity Type:Organization
Organization Name:MANHATTAN ORAL FACIAL SURGERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORAL AND MAXILLOFACIAL SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:JANET
Authorized Official - Middle Name:C
Authorized Official - Last Name:BODEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:212-567-5536
Mailing Address - Street 1:6118 RIVERDALE AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10471-1009
Mailing Address - Country:US
Mailing Address - Phone:929-222-3070
Mailing Address - Fax:212-202-6447
Practice Address - Street 1:6118 RIVERDALE AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10471-1009
Practice Address - Country:US
Practice Address - Phone:929-222-3070
Practice Address - Fax:212-202-6447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-20
Last Update Date:2019-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0542411223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty