Provider Demographics
NPI:1871006064
Name:NY ORAL AND MAXILLOFACIAL SURGEON, PC
Entity Type:Organization
Organization Name:NY ORAL AND MAXILLOFACIAL SURGEON, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWER
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:SCHWARTZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:718-946-6600
Mailing Address - Street 1:2844 OCEAN PKWY STE B2
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-7904
Mailing Address - Country:US
Mailing Address - Phone:718-946-6600
Mailing Address - Fax:718-996-2261
Practice Address - Street 1:2844 OCEAN PKWY STE B2
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-7904
Practice Address - Country:US
Practice Address - Phone:718-946-6600
Practice Address - Fax:718-996-2261
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-09
Last Update Date:2017-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0384431223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty