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NPI Code Detail

MEDICARE: JACK A. MAILMAN, DDS, LEONARD I. FLUG, DDS, P.C.

MEDICARE: JACK A. MAILMAN, DDS, LEONARD I. FLUG, DDS, P.C.
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
1261QD0000XDental Clinic/Center027631NY

General Provider Information

NPI Number : 1992724025
Entity Type Code : Organization
Provider Name (Legal Business Name) : JACK A. MAILMAN, DDS, LEONARD I. FLUG, DDS, P.C.
Provider Business Mailing Address
First Line : 1800 RICHMOND AVE
Second Line :
City : STATEN ISLAND
State : NY
Zip : 10314-3902
Country : US
Telephone Number : 718-761-1800
Fax Number : 718-761-6945
Provider Business Practice Location Address
First Line : 1800 RICHMOND AVE
Second Line :
City : STATEN ISLAND
State : NY
Zip : 10314-3902
Country : US
Telephone Number : 718-761-1800
Fax Number : 718-761-6945
Authorized Official
Title or Position : SECRETARY/TREASURER
Name : DR. JACK ALAN MAILMAN
Credential : D.D.S.
Telephone Number : 718-761-1800
Provider Enumeration Date : 07/19/2006
Last Update Date : 08/22/2020

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