Provider Demographics
NPI:1255796553
Name:YONKERS ORAL SURGERY, PLLC
Entity type:Organization
Organization Name:YONKERS ORAL SURGERY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:HELEN
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:914-472-5252
Mailing Address - Street 1:73 MARKET STREET
Mailing Address - Street 2:SUITE 377
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10710
Mailing Address - Country:US
Mailing Address - Phone:914-779-5606
Mailing Address - Fax:914-968-2474
Practice Address - Street 1:73 MARKET STREET
Practice Address - Street 2:SUITE 377
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10710
Practice Address - Country:US
Practice Address - Phone:914-779-5606
Practice Address - Fax:914-968-2474
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-31
Last Update Date:2016-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00678024 ETIN AJ19Medicaid
NYDODO11Medicare PIN