Provider Demographics
NPI:1912048844
Name:NEW YORK MAXILLOFACIAL SURGERY, P.C.
Entity Type:Organization
Organization Name:NEW YORK MAXILLOFACIAL SURGERY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORAL SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:
Authorized Official - Last Name:NEUGARTEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MD
Authorized Official - Phone:212-308-9200
Mailing Address - Street 1:110 E 55TH ST
Mailing Address - Street 2:15TH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-4540
Mailing Address - Country:US
Mailing Address - Phone:212-308-9200
Mailing Address - Fax:212-308-9212
Practice Address - Street 1:110 E 55TH ST
Practice Address - Street 2:15TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-4540
Practice Address - Country:US
Practice Address - Phone:212-308-9200
Practice Address - Fax:212-308-9212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2007-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY218337204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01335919Medicaid
NY00501157Medicaid
NY02238062Medicaid
NYD7I121Medicare ID - Type UnspecifiedSALVATORE RUGGIERO
NY00501157Medicaid
NYU32120Medicare UPIN
NYDE1671Medicare ID - Type UnspecifiedJAY NEUGARTEN
NY01335919Medicaid
NY02238062Medicaid