Provider Demographics
NPI:1760780621
Name:LONG ISLAND ORAL SURGERY ASSOCIATES PC
Entity Type:Organization
Organization Name:LONG ISLAND ORAL SURGERY ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:KEARNS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-421-2544
Mailing Address - Street 1:61 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-2812
Mailing Address - Country:US
Mailing Address - Phone:631-421-2544
Mailing Address - Fax:631-421-0948
Practice Address - Street 1:61 E MAIN ST
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-2812
Practice Address - Country:US
Practice Address - Phone:631-421-2544
Practice Address - Fax:631-421-0948
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-02
Last Update Date:2011-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0446561223S0112X
NY0415271223S0112X
NY0529781223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty