MEDICARE: NYC ORAL SURGERY ASSOCIATES

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	261QS0112X	Oral and Maxillofacial Surgery Clinic/Center	048825	NY

General Provider Information

NPI Number	:	1770819286
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NYC ORAL SURGERY ASSOCIATES

Provider Business Mailing Address
First Line	:	3353 82ND ST
Second Line	:	SUITE #A01
City	:	JACKSON HEIGHTS
State	:	NY
Zip	:	11372-1447
Country	:	US
Telephone Number	:	718-899-7811
Fax Number	:	347-665-1456

Provider Business Practice Location Address
First Line	:	3353 82ND ST
Second Line	:	SUITE #A01
City	:	JACKSON HEIGHTS
State	:	NY
Zip	:	11372-1447
Country	:	US
Telephone Number	:	718-899-7811
Fax Number	:	347-665-1456

Authorized Official
Title or Position	:	ORAL SURGEON
Name	:	ANTONIO DEL VALLE
Credential	:	DMD, MD
Telephone Number	:	917-450-6531

Provider Enumeration Date	:	10/19/2009
Last Update Date	:	08/24/2010

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