Provider Demographics
NPI:1831822923
Name:LONG ISLAND AMBULATORY FOR ORAL AND MAXILLOFACIAL SURGERY, PC
Entity type:Organization
Organization Name:LONG ISLAND AMBULATORY FOR ORAL AND MAXILLOFACIAL SURGERY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:
Authorized Official - Last Name:MENESHIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MD
Authorized Official - Phone:516-294-9696
Mailing Address - Street 1:134 MINEOLA BLVD FL 3
Mailing Address - Street 2:
Mailing Address - City:MINEOLA
Mailing Address - State:NY
Mailing Address - Zip Code:11501-3959
Mailing Address - Country:US
Mailing Address - Phone:516-294-9696
Mailing Address - Fax:516-294-3531
Practice Address - Street 1:134 MINEOLA BLVD FL 3
Practice Address - Street 2:
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501-3959
Practice Address - Country:US
Practice Address - Phone:516-294-9696
Practice Address - Fax:516-294-3531
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-06
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty