Provider Demographics
NPI:1831762467
Name:FACIAL AND ORAL SURGERY SPECIALISTS PLLC
Entity type:Organization
Organization Name:FACIAL AND ORAL SURGERY SPECIALISTS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TAREK
Authorized Official - Middle Name:
Authorized Official - Last Name:KORBAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MD
Authorized Official - Phone:914-500-8985
Mailing Address - Street 1:55 W RED OAK LN
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10604-3608
Mailing Address - Country:US
Mailing Address - Phone:914-500-8985
Mailing Address - Fax:914-500-8986
Practice Address - Street 1:55 W RED OAK LN
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10604-3608
Practice Address - Country:US
Practice Address - Phone:914-500-8985
Practice Address - Fax:914-500-8986
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-21
Last Update Date:2021-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03648886Medicaid