Provider Demographics
NPI:1770819286
Name:NYC ORAL SURGERY ASSOCIATES
Entity type:Organization
Organization Name:NYC ORAL SURGERY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORAL SURGEON
Authorized Official - Prefix:
Authorized Official - First Name:ANTONIO
Authorized Official - Middle Name:
Authorized Official - Last Name:DEL VALLE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MD
Authorized Official - Phone:917-450-6531
Mailing Address - Street 1:3353 82ND ST
Mailing Address - Street 2:SUITE #A01
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372-1447
Mailing Address - Country:US
Mailing Address - Phone:718-899-7811
Mailing Address - Fax:347-665-1456
Practice Address - Street 1:3353 82ND ST
Practice Address - Street 2:SUITE #A01
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-1447
Practice Address - Country:US
Practice Address - Phone:718-899-7811
Practice Address - Fax:347-665-1456
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-19
Last Update Date:2010-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY048825261QS0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial Surgery