Provider Demographics
NPI:1598029779
Name:ADVANCED ENDODONTICS OF LONG ISLAND, P.C.
Entity Type:Organization
Organization Name:ADVANCED ENDODONTICS OF LONG ISLAND, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEROME
Authorized Official - Middle Name:JACOB
Authorized Official - Last Name:CYMERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:631-751-1400
Mailing Address - Street 1:2500 NESCONSET HWY BLDG 18A
Mailing Address - Street 2:
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11790-2563
Mailing Address - Country:US
Mailing Address - Phone:631-751-1400
Mailing Address - Fax:631-751-1996
Practice Address - Street 1:2500 NESCONSET HWY BLDG 18A
Practice Address - Street 2:
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11790-2563
Practice Address - Country:US
Practice Address - Phone:631-751-1400
Practice Address - Fax:631-751-1996
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-02
Last Update Date:2012-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0355821223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty