MEDICARE: DR. SETH MARTIN BLACK DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	204E00000X	Oral & Maxillofacial Surgery (D.M.D.)	033118	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1093707036
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SETH MARTIN BLACK DDS

Provider Business Mailing Address
First Line	:	2 DONGAN WAY
Second Line	:
City	:	EAST HAMPTON
State	:	NY
Zip	:	11937
Country	:	US
Telephone Number	:	917-301-8675
Fax Number	:	212-755-5572

Provider Business Practice Location Address
First Line	:	2 DONGAN WAY
Second Line	:
City	:	EAST HAMPTON
State	:	NY
Zip	:	11937
Country	:	US
Telephone Number	:	917-301-8675
Fax Number	:	212-755-5572

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/16/2005
Last Update Date	:	10/24/2023

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