MEDICARE: DR. JONATHAN SAMUEL PALEY D.D.S.

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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	047156	NY

General Provider Information

NPI Number	:	1144269358
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JONATHAN SAMUEL PALEY D.D.S.

Provider Business Mailing Address
First Line	:	1229 BROADWAY
Second Line	:	SUITE 102
City	:	HEWLETT
State	:	NY
Zip	:	11557-2014
Country	:	US
Telephone Number	:	516-569-4567
Fax Number	:	516-374-9598

Provider Business Practice Location Address
First Line	:	1229 BROADWAY
Second Line	:	SUITE 102
City	:	HEWLETT
State	:	NY
Zip	:	11557-2014
Country	:	US
Telephone Number	:	516-569-4567
Fax Number	:	516-374-9598

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

Provider Enumeration Date	:	06/05/2006
Last Update Date	:	07/08/2007

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