Healthcare Provider Details

I. General information

NPI: 1942669387
Provider Name (Legal Business Name): BROOKLYN ORAL SURGERY & IMPLANT CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2016
Last Update Date: 02/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1512 AVENUE Z
BROOKLYN NY
11235-3808
US

IV. Provider business mailing address

1512 AVENUE Z
BROOKLYN NY
11235-3808
US

V. Phone/Fax

Practice location:
  • Phone: 718-395-4700
  • Fax: 718-395-4709
Mailing address:
  • Phone: 718-395-4700
  • Fax: 718-395-4709

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS0112X
TaxonomyOral and Maxillofacial Surgery Clinic/Center
License Number055345
License Number StateNY

VIII. Authorized Official

Name: DR. GARRY SHNAYDER
Title or Position: OWNER
Credential: DDS
Phone: 718-702-2003