MEDICARE: NY ORAL AND MAXILLOFACIAL SURGEON, PC

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	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	038443	NY

General Provider Information

NPI Number	:	1871006064
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NY ORAL AND MAXILLOFACIAL SURGEON, PC

Provider Business Mailing Address
First Line	:	2844 OCEAN PKWY STE B2
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11235-7904
Country	:	US
Telephone Number	:	718-946-6600
Fax Number	:	718-996-2261

Provider Business Practice Location Address
First Line	:	2844 OCEAN PKWY STE B2
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11235-7904
Country	:	US
Telephone Number	:	718-946-6600
Fax Number	:	718-996-2261

Authorized Official
Title or Position	:	OWER
Name	:	STEVEN RICHARD SCHWARTZ
Credential	:	DDS
Telephone Number	:	718-946-6600

Provider Enumeration Date	:	11/09/2017
Last Update Date	:	11/09/2017

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