Provider Demographics
NPI:1760762934
Name:WEITZMAN ORAL SURGERY AND IMPLANTOLOGY
Entity Type:Organization
Organization Name:WEITZMAN ORAL SURGERY AND IMPLANTOLOGY
Other - Org Name:ORAL SURGERY AND IMPLANT CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:WEITZMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:718-275-5700
Mailing Address - Street 1:11203 QUEEND BLVD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375
Mailing Address - Country:US
Mailing Address - Phone:718-275-5700
Mailing Address - Fax:718-275-5279
Practice Address - Street 1:11203 QUEEND BLVD
Practice Address - Street 2:SUITE 202
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375
Practice Address - Country:US
Practice Address - Phone:718-275-5700
Practice Address - Fax:718-275-5279
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-19
Last Update Date:2015-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0337091223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty