Provider Demographics
NPI:1982323036
Name:OMS NEW YORK ORAL SURGERY PC
Entity Type:Organization
Organization Name:OMS NEW YORK ORAL SURGERY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:GLIED
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:917-364-3854
Mailing Address - Street 1:501 MADISON AVE FL 18
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-5613
Mailing Address - Country:US
Mailing Address - Phone:917-364-3854
Mailing Address - Fax:
Practice Address - Street 1:501 MADISON AVE FL 18
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-5613
Practice Address - Country:US
Practice Address - Phone:212-308-9200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-23
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03118196Medicaid