Healthcare Provider Details

I. General information

NPI: 1669247458
Provider Name (Legal Business Name): EASTERN LONG ISLAND ORAL SURGERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2023
Last Update Date: 11/21/2023
Certification Date: 11/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

760-10 MONTAUK HWY
CENTER MORICHES NY
11934
US

IV. Provider business mailing address

760-10 MONTAUK HWY
CENTER MORICHES NY
11934
US

V. Phone/Fax

Practice location:
  • Phone: 631-878-9300
  • Fax:
Mailing address:
  • Phone: 631-878-9300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State

VIII. Authorized Official

Name: DR. STEPHEN SOKOLOFF
Title or Position: PRESIDENT
Credential: DDS
Phone: 631-878-9300